The reciprocal relationships between loneliness and antiretroviral therapy adherence in persons with HIV: a two-wave cross-lagged model.

Loneliness has been linked to medication-taking behaviors in the general population, yet its role in antiretroviral therapy (ART) adherence among persons with HIV (PWH) remains less understood. This study examined whether loneliness is a risk factor for, or consequence of, poor ART adherence. We conducted a secondary analysis of an observational study on racial disparities in health outcomes among PWH in the Southeastern United States. A cross-lag model tested reciprocal relationships between loneliness (PROMIS-Social Isolation Scale) and self-reported ART adherence across two time points (baseline and 6-month follow-up). Complete cases on both variables yielded a sample of 153 participants (mean age=46.3; 28.1% female; 64.7% Black). Adjusting for depressive symptoms, life stressors, HIV-related stigma and age, the results indicated that baseline loneliness predicted greater loneliness at follow-up (β=0.68, p<.001) and lower ART adherence (β=-0.28, p=.003). Baseline adherence predicted future adherence (β=0.36, p<.001) but not future loneliness (β=0.02, p=.73). Older age was positively associated with adherence (β=0.16, p=.02). The findings suggest that loneliness undermines ART adherence over time, highlighting the need for interventions in community and clinical settings that address loneliness to improve long-term HIV care outcomes.