International journal of behavioral medicine · 2026
Associations Between HIV Infection Status, Psychosocial Factors, and Adjuvant Endocrine Therapy Adherence Among South African Women with Stage I-III Breast Cancer.
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O'Neil Daniel S, Blanchard Charmaine L, Ream Molly, Mmoledi Keletso Constance, Mkwanazi Nontlantla, Shandukani Victor, Ruff Paul, Joffe Maureen, Antoni Michael
Аннотация
BACKGROUND: South African women with breast cancer (BC) and comorbid HIV experience increased mortality compared to other patients with BC. We aimed to evaluate associations between HIV status, psychosocial factors, and adjuvant endocrine therapy (AET) adherence as a potential contributor to this disparity.
METHOD: We conducted a prospective observational study, enrolling women with stage I-III hormone receptor-positive (HR+) BC in remission and prescribed AET from the Chris Hani Baragwanath Academic Hospital (CHBAH) in Johannesburg. We performed AET pill counts at enrollment, 12 weeks, and 24 weeks, and calculated adherence ratios of pills consumed between visits to days between visits. We used hierarchical linear (HLM) and structural equation modeling (SEM) to compare adherence ratios between women with and without HIV while adjusting for psychosocial factors, including social support, attitude toward medication, health literacy, self-efficacy, mental health, AET toxicity, and household wealth.
RESULTS: We collected adherence data from 239 women, 63 (26.4%) with comorbid HIV. Comparing women with and without HIV, median AET adherence ratio was 0.88 vs 0.89, respectively (HLM p = 0.31). Decreased adherence ratio was associated with greater specific concerns about using AET (β -0.01, SE 0.003, p = 0.001) and greater anxiety (β -0.01, SE 0.002, p = 0.04). Across individual 12-week periods, adherence ratios for women with and without HIV were ≥ 80% in 54.2% and 61.0% of periods, respectively (chi-square p = 0.24).
CONCLUSION: There was no statistically significant difference in median AET adherence based on HIV status among SA women with HR+ BC, though there was a numerical decrease in women with HIV who met an 80% threshold. Differences in attitudes toward AET and anxiety may predict adherence and are potential targets for intervention research.
METHOD: We conducted a prospective observational study, enrolling women with stage I-III hormone receptor-positive (HR+) BC in remission and prescribed AET from the Chris Hani Baragwanath Academic Hospital (CHBAH) in Johannesburg. We performed AET pill counts at enrollment, 12 weeks, and 24 weeks, and calculated adherence ratios of pills consumed between visits to days between visits. We used hierarchical linear (HLM) and structural equation modeling (SEM) to compare adherence ratios between women with and without HIV while adjusting for psychosocial factors, including social support, attitude toward medication, health literacy, self-efficacy, mental health, AET toxicity, and household wealth.
RESULTS: We collected adherence data from 239 women, 63 (26.4%) with comorbid HIV. Comparing women with and without HIV, median AET adherence ratio was 0.88 vs 0.89, respectively (HLM p = 0.31). Decreased adherence ratio was associated with greater specific concerns about using AET (β -0.01, SE 0.003, p = 0.001) and greater anxiety (β -0.01, SE 0.002, p = 0.04). Across individual 12-week periods, adherence ratios for women with and without HIV were ≥ 80% in 54.2% and 61.0% of periods, respectively (chi-square p = 0.24).
CONCLUSION: There was no statistically significant difference in median AET adherence based on HIV status among SA women with HR+ BC, though there was a numerical decrease in women with HIV who met an 80% threshold. Differences in attitudes toward AET and anxiety may predict adherence and are potential targets for intervention research.