Understanding the Role of Resilience Resources, Antiretroviral Therapy Initiation, and HIV-1 RNA Suppression among People Living with HIV in South Africa: a Prospective Cohort Study

Objective: Failure to initiate antiretroviral therapy (ART) and achieve virologic suppression are significant barriers to the United Nations 90–90–90 goals. Identifying resilience resources, or modifiable strength-based factors, among people living with HIV is critical for successful HIV treatment and prevention. Design: Prospective cohort study. Methods: From July 2014 to July 2015, 500 adults presenting for voluntary counseling and HIV testing who were diagnosed with HIV and were ART-eligible in South Africa (Soweto and Gugulethu) were enrolled and surveyed. Logistic regression models assessed resilience-related predictors of ART initiation within 6 months of voluntary counseling and HIV testing for HIV, and HIV-1 plasma RNA suppression within 9 months, adjusting for sociodemographic factors. Results: Within 6 months, 62% initiated ART, and within 9 months, 25% had evidence of an undetectable HIV-1 plasma RNA (<50 copies/ml). Participants who initiated ART relied less on social support from friends [adjusted odds ratio (aOR) 0.94, 95% confidence interval (CI): 0.89–0.99], coped using self-distraction (aOR 1.05, 95% CI: 1.00–1.10) and avoided coping through substance use (aOR 0.79, 95% CI: 0.65–0.97), as compared with participants who did not initiate ART. Those who achieved plasma RNA suppression relied more on social support from a significant other/partner (aOR 1.04, 95% CI: 1.02–1.07), used positive religious coping (aOR 1.03, 95% CI: 1.00–1.07), and were less likely to engage in denial coping (aOR 0.84, 95% CI: 0.77–0.92), compared with those who initiated ART but did not achieve plasma RNA suppression. Conclusion: Interventions optimizing resilience resources and decreasing maladaptive coping strategies (e.g., substance use, denial) may present a feasible approach to maximizing ART-based HIV treatment strategies among South African people living with HIV.