Skip to main content

Advertisement

SpringerLink
Log in

The Role of Religious Service Attendance, Psychosocial and Behavioral Determinants of Antiretroviral Therapy (ART) Adherence: Results from HPTN 063 Cohort Study

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Early and sustained antiretroviral therapy (ART) adherence can suppress the HIV virus in individuals and reduce onward transmission of HIV in the population. Religiosity has been associated with better HIV clinical outcomes. Data are from a longitudinal, observational study of 749 HIV-infected individuals from Brazil, Zambia, and Thailand (HPTN 063). Ordered logistic regression assessed whether religious service attendance was associated with ART adherence (self-reported and plasma HIV-RNA) and moderated the association between alcohol problems and ART adherence. In each country, > 80% of participants reported high self-reported ART adherence (good/very good/excellent). Religious service attendance exceeded 85% but was statistically unrelated to adherence. In combined-country models, (p = 0.03) as alcohol problems increased, the probability of high self-reported ART adherence, as well as viral-load, became weaker at higher compared to low service attendance frequency. Future studies should evaluate spirituality variables and replicate the moderation analyses between religious attendance and alcohol problems.

Resumen

La adherencia temprana y sostenida a la terapia antirretroviral (TAR) puede suprimir el virus del VIH en los individuos y reducir la transmisión del VIH en la población. La religiosidad se ha asociado con mejores resultados clínicos del VIH. Los datos provienen de un estudio observacional longitudinal de 749 individuos infectados con VIH de Brasil, Zambia y Tailandia (HPTN 063). La regresión logística ordenada evaluó si la asistencia al servicio religioso estaba asociada con la adherencia al TAR (autoreportado y el ARN del VIH en plasma) y moderaba la asociación entre los problemas del alcohol y la adherencia al TAR. En cada país, > 80% de los participantes reportaron un alto cumplimiento autoreportado de ART (bueno/muy bueno/excelente). La asistencia al servicio religioso excedió el 85%, pero estadísticamente no estuvo relacionada con la adherencia. En los modelos de países combinados, (p = 0.03) a medida que aumentaban los problemas de alcohol, la probabilidad de una alta adherencia autoreportada al TAR, así como la carga viral, se debilitó a una frecuencia de asistencia más alta en comparación con la baja. Los estudios futuros deberían evaluar las variables de espiritualidad y reproducir los análisis de moderación entre asistencia religiosa y problemas con el alcohol.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Pew Research Center. The global religious landscape: a report on the size and distribution of the world’s major religious groups as of 2010 Washington, DC: Pew Research Center. 2012. http://www.webcitation.org/query?url=http%3A%2F%2Fwww.pewforum.org%2F2012%2F12%2F18%2Fglobal-religious-landscape-exec%2F&date=2017-04-03. Accessed 4 Mar 2017.

  2. Idler EL, editor. Religion as a social determinant of public health. New York: Oxford University Press; 2014.

    Google Scholar 

  3. Williams DR, Sternthal MJ. Spirituality, religion and health: evidence and research directions. Med J Aust. 2007;186(10):S47–50.

    PubMed  Google Scholar 

  4. Nelson JM. Religion, spirituality, and physical health. In: Nelson JM, editor. Psychology, religion and spirituality. New York: Springer; 2009. p. 311–47.

    Chapter  Google Scholar 

  5. Muñoz-Laboy M, Garcia J, Moon-Howard J, Wilson PA, Parker R. Religious responses to HIV and AIDS: understanding the role of religious cultures and institutions in confronting the epidemic. Glob Public Health. 2011;6(sup2):S127–31.

    Article  PubMed  Google Scholar 

  6. Doolittle BR, Justice AC, Fiellin DA. Religion, spirituality, and HIV clinical outcomes: a systematic review of the literature. AIDS Behav. 2016. https://doi.org/10.1007/s10461-016-1651-z.

    Article  Google Scholar 

  7. Medved Kendrick H. Are religion and spirituality barriers or facilitators to treatment for HIV: a systematic review of the literature. AIDS Care. 2017;29(1):1–13.

    Article  Google Scholar 

  8. Trickey A, May MT, Vehreschild J-J, Obel N, Gill MJ, Crane HM, et al. Survival of HIV-positive patients starting antiretroviral therapy between 1996 and 2013: a collaborative analysis of cohort studies. Lancet HIV. 2017;4(8):e349–56.

    Article  Google Scholar 

  9. Murphy EL, Collier AC, Kalish LA, et al. Highly active antiretroviral therapy decreases mortality and morbidity in patients with advanced HIV disease. Ann Intern Med. 2001;135(1):17–26.

    Article  CAS  PubMed  Google Scholar 

  10. Rai S, Mahapatra B, Sircar S, Raj PY, Venkatesh S, Shaukat M, et al. Adherence to antiretroviral therapy and its effect on survival of HIV-infected individuals in Jharkhand, India. PLoS ONE. 2013;8(6):e66860.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kakinami L, de Bruyn G, Pronyk P, Mohapi L, Tshabangu N, Moshabela M, et al. The impact of highly active antiretroviral therapy on activities of daily living in HIV-infected adults in South Africa. AIDS Behav. 2011;15(4):823–31.

    Article  PubMed  Google Scholar 

  12. Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Grinsztejn B, Hosseinipour MC, Ribaudo HJ, Swindells S, Eron J, Chen YQ, et al. Effects of early versus delayed initiation of antiretroviral treatment on clinical outcomes of HIV-1 infection: results from the phase 3 HPTN 052 randomised controlled trial. Lancet Infect Dis. 2014;14(4):281–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Grant RM, Lama JR, Anderson PL, McMahan V, Liu AY, Vargas L, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363(27):2587–99.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Günthard HF, Saag MS, Benson CA, Del Rio C, Eron JJ, Gallant JE, et al. Antiretroviral drugs for treatment and prevention of HIV infection in adults: 2016 recommendations of the International Antiviral Society–USA panel. JAMA. 2016;316(2):191–210.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Pargament KI, McCarthy S, Shah P, Ano G, Tarakeshwar N, Wachholtz A, et al. Religion and HIV: a review of the literature and clinical implications. South Med J. 2004;97(12):1201–10.

    Article  PubMed  Google Scholar 

  17. Bazant ES, Boulay M. Factors associated with religious congregation members’ support to people living with HIV/AIDS in Kumasi, Ghana. AIDS Behav. 2007;11(6):936–45.

    Article  PubMed  Google Scholar 

  18. Levin JS. Religion and health: is there an association, is it valid, and is it causal? Soc Sci Med. 1994;38(11):1475–82.

    Article  CAS  PubMed  Google Scholar 

  19. Ellison CG, Levin JS. The religion-health connection: evidence, theory, and future directions. Health Educ Behav. 1998;25(6):700–20.

    Article  CAS  PubMed  Google Scholar 

  20. Park J, Nachman S. The link between religion and HAART adherence in pediatric HIV patients. AIDS Care. 2010;22(5):556–61.

    Article  PubMed  Google Scholar 

  21. Van Wagoner N, Elopre L, Westfall AO, Mugavero MJ, Turan J, Hook EW. Reported church attendance at the time of entry into HIV care is associated with viral load suppression at 12 months. AIDS Behav. 2016;20(8):1706–12.

    Article  PubMed  Google Scholar 

  22. Dalmida SG, McCoy K, Koenig HG, Miller A, Holstad MM, Thomas T, et al. Examination of the role of religious and psychosocial factors in HIV medication adherence rates. J Relig Health. 2017;56(6):2144–61.

    Article  PubMed  Google Scholar 

  23. Kelly-Hanku A, Aggleton P, Shih P. I shouldn’t talk of medicine only: biomedical and religious frameworks for understanding antiretroviral therapies, their invention and their effects. Glob Public Health. 2017. https://doi.org/10.1080/17441692.2017.1377746.

    Article  PubMed  Google Scholar 

  24. Bluthenthal RN, Palar K, Mendel P, Kanouse DE, Corbin DE, Derose KP. Attitudes and beliefs related to HIV/AIDS in urban religious congregations: barriers and opportunities for HIV-related interventions. Soc Sci Med. 2012;74(10):1520–7.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wanyama J, Castelnuovo B, Wandera B, Mwebaze P, Kambugu A, Bangsberg DR, et al. Belief in divine healing can be a barrier to antiretroviral therapy adherence in Uganda. AIDS. 2007;21(11):1486–7.

    Article  PubMed  Google Scholar 

  26. Finocchario-Kessler S, Catley D, Berkley-Patton J, Gerkovich M, Williams K, Banderas J, et al. Baseline predictors of ninety percent or higher antiretroviral therapy adherence in a diverse urban sample: the role of patient autonomy and fatalistic religious beliefs. AIDS Patient Care STDS. 2011;25(2):103–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Vyas KJ, Limneos J, Qin H, Mathews WC. Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons. AIDS Care. 2014;26(8):983–7.

    Article  PubMed  Google Scholar 

  28. Tumwine C, Neema S, Wagner G. Reasons why high religiosity can co-exist with and precipitate discontinuation of anti-retroviral therapy among different HIV clients in Uganda: an exploratory study. Religions. 2012;3(3):817–32.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Pichon LC, Rossi KR, Ogg SA, Krull LJ, Griffin DY. Social support, stigma and disclosure: examining the relationship with HIV medication adherence among Ryan White Program Clients in the Mid-South USA. Int J Environ Res Public Health. 2015;12(6):7073–84.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kumarasamy N, Safren SA, Raminani SR, Pickard R, James R, Krishnan AKS, et al. Barriers and facilitators to antiretroviral medication adherence among patients with HIV in Chennai, India: a qualitative study. AIDS Patient Care STD. 2005;19(8):526–37.

    Article  CAS  Google Scholar 

  31. Szaflarski M. Spirituality and religion among HIV-infected individuals. Curr HIV/AIDS Rep. 2013;10(4):324–32.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Parsons SK, Cruise PL, Davenport WM, Jones V. Religious beliefs, practices and treatment adherence among individuals with HIV in the southern United States. AIDS Patient Care STDs. 2006;20(2):97–111.

    Article  PubMed  Google Scholar 

  33. Kisenyi R, Muliira J, Ayebare E. Religiosity and adherence to antiretroviral therapy among patients attending a public hospital-based HIV/AIDS clinic in Uganda. J Relig Health. 2013;52(1):307–17.

    Article  PubMed  Google Scholar 

  34. Borders TF, Curran GM, Mattox R, Booth BM. Religiousness among at-risk drinkers: is it prospectively associated with the development or maintenance of an alcohol-use disorder? J Stud Alcohol Drugs. 2010;71(1):136–42.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Lambert NM, Fincham FD, Marks LD, Stillman TF. Invocations and intoxication: does prayer decrease alcohol consumption? Psychol Addict Behav. 2010;24(2):209–19.

    Article  PubMed  Google Scholar 

  36. Parsons JT, Rosof E, Mustanski B. The temporal relationship between alcohol consumption and HIV-medication adherence: a multilevel model of direct and moderating effects. Health Psychol. 2008;27(5):628–37.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Sileo KM, Simbayi LC, Abrams A, Cloete A, Kiene SM. The role of alcohol use in antiretroviral adherence among individuals living with HIV in South Africa: event-level findings from a daily diary study. Drug Alc Depend. 2016;167:103–11.

    Article  Google Scholar 

  38. Kahler CW, Liu T, Cioe PA, Bryant V, Pinkston MM, Kojic EM, et al. Direct and indirect effects of heavy alcohol use on clinical outcomes in a longitudinal study of HIV patients on ART. AIDS Behav. 2016;21(7):1825.

    Article  Google Scholar 

  39. Williams EC, Hahn JA, Saitz R, Bryant K, Lira MC, Samet JH. Alcohol use and Human Immunodeficiency Virus (HIV) infection: current knowledge, implications, and future directions. Alcohol Clin Exp Res. 2016;40(10):2056–72.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Hahn JA, Woolf-King SE, Muyindike W. Adding fuel to the fire: alcohol’s effect on the HIV epidemic in Sub-Saharan Africa. Curr HIV/AIDS Rep. 2011;8(3):172.

    Article  PubMed  Google Scholar 

  41. Magidson J, Li X, Mimiaga M, Moore A, Srithanaviboonchai K, Friedman R, et al. Antiretroviral medication adherence and amplified HIV transmission risk among sexually active HIV-infected individuals in three diverse international settings. AIDS Behav. 2015. https://doi.org/10.1007/s10461-015-1142-7.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Kalichman SC, Simbayi LC, Vermaak R, Cain D, Smith G, Mthebu J, et al. Randomized trial of a community-based alcohol-related HIV risk-reduction intervention for men and women in Cape Town South Africa. Ann Behav Med. 2008;36(3):270–9.

    Article  PubMed  Google Scholar 

  43. Safren SA, Hughes JP, Mimiaga MJ, Moore AT, Friedman RK, Srithanaviboonchai K, et al. Frequency and predictors of estimated HIV transmissions and bacterial STI acquisition among HIV-positive patients in HIV care across three continents. J Int AIDS Soc. 2016;19(1):21096.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Feldman B, Fredericksen R, Crane PK, Safren S, Mugavero M, Willig JH, et al. Evaluation of the single-item self-rating adherence scale for use in routine clinical care of people living with HIV. AIDS Behav. 2013;17(1):307–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Lu M, Safren SA, Skolnik PR, Rogers WH, Coady W, Hardy H, et al. Optimal recall period and response task for self-reported HIV medication adherence. AIDS Behav. 2008;12(1):86–94.

    Article  PubMed  Google Scholar 

  46. Ojikutu BO, Pathak S, Srithanaviboonchai K, Limbada M, Friedman R, Li S, et al. Community cultural norms, stigma and disclosure to sexual partners among women living with HIV in Thailand, Brazil and Zambia (HPTN 063). PLoS ONE. 2016;11(5):e0153600.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  47. VanderWeele TJ, Li S, Tsai AC, Kawachi I. Association between religious service attendance and lower suicide rates among US women. JAMA Psychiatry. 2016;73(8):845–51.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ransome Y, Gilman SE. The role of religious involvement in black-white differences in alcohol use disorders. J Stud Alc Drugs. 2016;In Press.

  49. Zimet GD, Powell SS, Farley GK, Werkman S, Berkoff KA. Psychometric characteristics of the multidimensional scale of perceived social support. J Pers Assess. 1990;55(3–4):610–7.

    Article  CAS  PubMed  Google Scholar 

  50. Saunders JB, Aasland OG, Babor TF, De la Fuente JR, Grant M. Development of the alcohol use disorders identification test (AUDIT). WHO collaborative project on early detection of persons with harmful alcohol consumption-II. Addiction. 1993;88:791–804.

    Article  CAS  PubMed  Google Scholar 

  51. Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful selection of variables in logistic regression. Source Code Biol Med. 2008;3(1):17.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Jaccard J, Wan CK, Turrisi R. The detection and interpretation of interaction effects between continuous variables in multiple regression. Multivar Behav Res. 1990;25(4):467–78.

    Article  CAS  Google Scholar 

  53. Gunzler D, Chen T, Wu P, Zhang H. Introduction to mediation analysis with structural equation modeling. Shanghai Arch Psychiatry. 2013;25(6):390–4.

    PubMed  PubMed Central  Google Scholar 

  54. StataCorp. Stata statistical software: Release 14.0. College Station: StataCorp LP; 2015.

    Google Scholar 

  55. Kenny DA. Mediation 2016. http://www.webcitation.org/query?url=http%3A%2F%2Fdavidakenny.net%2Fcm%2Fmediate.htm&date=2017-01-31. Accessed 31 Jan 2017.

  56. Miller WR. Researching the spiritual dimensions of alcohol and other drug problems. Addiction. 1998;93(7):979–90.

    Article  CAS  PubMed  Google Scholar 

  57. McGrath J. A glutton and a drunkard: what would Jesus drink? In: Robertson KC, editor. Religion and alcohol: Sobering thoughts. New York: Peter Lang Publishing Inc; 2004. p. 11–44.

    Google Scholar 

  58. Adong J, Lindan C, Fatch R, Emenyonu NI, Muyindike WR, Ngabirano C, et al. The relationship between spirituality/religiousness and unhealthy alcohol use among HIV-infected adults in Southwestern Uganda. AIDS Behav. 2017. https://doi.org/10.1007/s10461-017-1805-7.

    Article  Google Scholar 

  59. AVERT.org. HIV and AIDS in Brazil United Kingdom, 2017. http://www.webcitation.org/query?url=https%3A%2F%2Fwww.avert.org%2Fprofessionals%2Fhiv-around-world%2Flatin-america%2Fbrazil%23Barriers%2520to%2520HIV%2520prevention%2520in%2520Brazil&date=2018-03-27. Accessed 27 Mar 2018.

  60. Qiao S, Li X, Stanton B. Social support and HIV-related risk behaviors: a systematic review of the global literature. AIDS Behav. 2014;18(2):419–41.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Fiala WE, Bjorck JP, Gorsuch R. The religious support scale: construction, validation, and cross-validation. Am J Commun Psychol. 2002;30(6):761–86.

    Article  Google Scholar 

  62. Cochran JK, Beeghley L, Bock EW. Religiosity and alcohol behavior: an exploration of reference group theory. Sociol Forum. 1988;3(2):256–76.

    Article  Google Scholar 

  63. Malow R, Dévieux JG, Stein JA, Rosenberg R, Jean-Gilles M, Attonito J, et al. Depression, substance abuse and other contextual predictors of adherence to antiretroviral therapy (ART) among Haitians. AIDS Behav. 2013;17(4):1221–30.

    Article  PubMed  Google Scholar 

  64. Blashill AJ, Bedoya CA, Mayer KH, O’Cleirigh C, Pinkston MM, Remmert JE, et al. Psychosocial syndemics are additively associated with worse ART adherence in HIV-infected individuals. AIDS Behav. 2015;19(6):981–6.

    Article  PubMed  PubMed Central  Google Scholar 

  65. da Silva CM, Mendoza-Sassi RA, da Mota LD, Nader MM, de Martinez AMB. Alcohol use disorders among people living with HIV/AIDS in Southern Brazil: prevalence, risk factors and biological markers outcomes. BMC Infect Dis. 2017;17:263.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Goodman MS. Comparison of small-area analysis techniques for estimating prevalence by race. Prev Chronic Dis. 2010;7(2):A33.

    PubMed  PubMed Central  Google Scholar 

  67. Trevino KM, Pargament KI, Cotton S, Leonard AC, Hahn J, Caprini-Faigin CA, et al. Religious coping and physiological, psychological, social, and spiritual outcomes in patients with HIV/AIDS: cross-sectional and longitudinal findings. AIDS Behav. 2010;14(2):379–89.

    Article  PubMed  Google Scholar 

  68. Zinnbauer BJ, Pargament KI, Cole B, Rye MS, Butter EM, Belavich TG, et al. Religion and spirituality: unfuzzying the fuzzy. J Sci Study Relig. 1997;36(4):549–64.

    Article  Google Scholar 

  69. Powell LH, Shahabi L, Thoresen CE. Religion and spirituality: linkages to physical health. Am Psychol. 2003;58(1):36–52.

    Article  PubMed  Google Scholar 

  70. Tarakeshwar N, Khan N, Sikkema KJ. A relationship-based framework of spirituality for individuals with HIV. AIDS Behav. 2006;10(1):59–70.

    Article  PubMed  Google Scholar 

  71. Ironson G, Stuetzle R, Fletcher MA. An increase in religiousness/spirituality occurs after HIV diagnosis and predicts slower disease progression over 4 years in people with HIV. J Gen Intern Med. 2006;21(S5):S62–8.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

Yusuf Ransome received funding from research grant from the National Institutes of Health/National Institute of Allergy and Infectious Diseases (Grant Number UM1 A1068619). HPTN 063 was funded by the Division of AIDS (DAIDS), National Institute of Allergy and Infectious Disease (NIAID), National Institute on Drug Abuse (NIDA) and the National Institute of Mental Health (NIMH) under Cooperative Agreement # UM1AI068619. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or The HIV Prevention Trials Network. Steven A. Safren time was also supported by the National Institutes of Health (NIH) research Grant (9K24DA040489). Yusuf Ransome time was also supported by the National Institute of Mental Health research Grant (K01MH111374). Kiyomi Tsuyuki time was supported by the National Institute of Alcohol Abuse and Alcoholism (K01AA025009).

Author information

Authors and Affiliations

  1. Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, LEPH 4th Floor, New Haven, CT, 06510, USA

    Yusuf Ransome

  2. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA

    Yusuf Ransome

  3. The Fenway Institute, Fenway Health, Boston, MA, USA

    Kenneth H. Mayer

  4. Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA

    Kenneth H. Mayer

  5. Harvard Medical School, Boston, MA, USA

    Kenneth H. Mayer

  6. Division of Global Public Health, School of Medicine, University of San Diego, San Diego, CA, USA

    Kiyomi Tsuyuki

  7. Department of Social and Behavioral Sciences, Brown University School of Public Health, Providence, RI, USA

    Matthew J. Mimiaga

  8. University of Puerto Rico School of Public Health, San Juan, PR, USA

    Carlos E. Rodriguez-Diaz

  9. Faculty of Medicine, and Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand

    Kriengkrai Srithanaviboonchai

  10. Instituto de Pesquisa Clinica Evandro Chagas, Rio de Janeiro, Brazil

    Ruth K. Friedman

  11. Zambart, Lusaka, Zambia

    Mohammed Limbada

  12. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Steven A. Safren

Authors
  1. Yusuf Ransome
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kenneth H. Mayer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kiyomi Tsuyuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Matthew J. Mimiaga
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Carlos E. Rodriguez-Diaz
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kriengkrai Srithanaviboonchai
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ruth K. Friedman
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Mohammed Limbada
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Steven A. Safren
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

for the HIV Prevention Trials Network 063 Team

Corresponding author

Correspondence to Yusuf Ransome.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

Ethnical considerations reviewed and approved by institutional review boards (IRB) within each recruitment country.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ransome, Y., Mayer, K.H., Tsuyuki, K. et al. The Role of Religious Service Attendance, Psychosocial and Behavioral Determinants of Antiretroviral Therapy (ART) Adherence: Results from HPTN 063 Cohort Study. AIDS Behav 23, 459–474 (2019). https://doi.org/10.1007/s10461-018-2206-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-018-2206-2

Keywords

Search

Navigation