ArticleInternational journal of behavioral medicine2026
Associations Between HIV Infection Status, Psychosocial Factors, and Adjuvant Endocrine Therapy Adherence Among South African Women with Stage I-III Breast Cancer.
Article in International journal of behavioral medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundSouth 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.
methodWe 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.
resultsWe 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).
conclusionThere 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.
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