4 - (Sym 35) Factors Associated with Antiretroviral Therapy Adherence Among a Community-based Sample of Sexual Minority Older Adults

Background: Sexual minority (e.g., gay, bisexual) older adults living with HIV (OALWH) are at risk for poor HIV-related care outcomes due to their frequent experience with both psychosocial challenges and structural barriers to care. The aim of the present study is to utilize a theoretical grounding in the literature and stochastic search variable selection (SSVS) approach to explore potential psychosocial and structural factors associated with ART adherence among a community-based sample of OALWH (50+ years) in south Florida, an U.S. HIV-epidemic epicenter.

Methods: A sample of sexual minority OALWH (N = 150) from a larger longitudinal cohort completed a baseline interviewer-administered assessment (in English or Spanish) from April 2017 to February 2021. Assessments include questions related to a) structural barriers to care, b) psychological functioning, and c) basic HIV-care outcomes (e.g., ART adherence). The SSVS method was employed to select potential facilitators associated with ART adherence that could then be placed in simple linear regression models using a stepwise addition approach.

Results: Participants were on average 56.5 years old (SD = 5.18) with the majority identifying as White/Hispanic (48.0%), cisgender male (86.7%), and gay, lesbian, or homosexual (60.0%). Average ART adherence was 91.0% (SD = 19.21) within this sample. The SSVS approach identified several structural (i.e., housing instability, education level) and psychosocial (i.e., illicit substance use, nicotine use, depression, anxiety, history of child abuse, and PTSD symptoms) factors that could be related to ART adherence among this population. A stepwise-addition regression approach yielded a final linear regression model (F_1,137 = 19.24, p = < 0.01) which suggested that housing (b = -17.89, p = < 0.01), illicit substance use (b = -16.17, p = < 0.01), nicotine use (b = -6.15, p < 0.05), and depression (b = -0.54, p = < 0.05) were all factors significantly associated with ART adherence among this group.

Conclusions: The present study is one of the first to specifically assess factors related to ART adherence in a community sample of sexual minority OALWH living in an epicenter of the U.S. HIV-epidemic. Further research is needed to not only identify potential mechanisms that may mediate the relationship between these identified factors and ART adherence, but also pinpoint valuable foci for cognitive-behavioral interventions to improve ART adherence among this underserved group.