Material Hardship, Perceived Stress, and Medication Adherence Among Treatment-Experienced People Living with HIV in Rural Zambia

Introduction: The intersection of poverty and HIV/AIDS creates a cycle, with poverty increasing risk to HIV exposure and infection, and HIV/AIDS in turn heightening vulnerability to poverty. Further, economic disadvantage adversely influences psychosocial well-being. Economic insecurity and poor psychosocial functioning are barriers to better HIV care and treatment outcomes, including adherence to antiretroviral therapy. However, limited research has been done to examine the association of economic insecurity on stress and adherence of people living with HIV (PLHIV) in rural and low-resource communities. This study examines the role of material hardship on stress and adherence levels of treatment-experienced PLHIV in rural Zambia.

Methods: This study used cross-sectional data from 101 PLHIV in Lundazi District, Eastern Province. Lundazi District and Eastern Province are predominantly rural, with more than 80% of the population living in rural communities. Data were collected using survey and hospital records. Material hardship was measured using a 5-item scale that asked how frequent respondents had resources to meet their needs. Stress was measured using the 10-item perceived stress scale. Adherence was a binary variable measured using a visual analog scale and medication possession ratio obtained from hospital data. We performed multiple imputation to address missing data issues. Multivariable linear and logistic regressions were used to examine the association of material hardship on stress and medication adherence.

Results: Less than 10% of respondents reported having enough money to meet medical care needs and other household needs most of the time. Less than 20% reported having enough money to meet food and clothing needs most of the time. Multivariable results indicated that material hardship was a significant predictor of perceived stress and medication adherence. Treatment-experienced PLHIV who experienced greater material hardship were more likely to have higher levels of stress (β = -0.44, 95% CI -0.77, -0.10, p = 0.01). Further, greater material hardship reduced the likelihood of adhering to HIV treatment (O.R. = 1.22, 95% CI 1.02, 1.47, p= 0.03).

Discussion: Material hardship, or the lack of adequate resources to meet household needs, adversely influence health and psychosocial functioning of PLHIV in rural communities. Our findings highlight the importance of providing treatment-experienced PLHIV with opportunities, through targeted social protection or appropriate livelihood programs that will allow them to satisfy basic needs on a regular basis. Addressing material hardship among PLHIV is critical to improve quality of life and HIV treatment outcomes, which in turn, may reduce HIV incidence and lower morbidity and mortality rates among PLHIV.