A prospective study of predictors of adherence to combination antiretroviral medication

AbstractOBJECTIVE: Adherence to complex antiretroviral therapy (ART) is critical for HIV treatment but difficult to achieve. The development of interventions to improve adherence requires detailed information regarding barriers to adherence. However, short follow-up and inadequate adherence measures have hampered such determinations. We sought to assess predictors of long-term (up to 1 year) adherence to newly initiated combination ART using an accurate, objective adherence measure. DESIGN: A prospective cohort study of 140 HIV-infected patients at a county hospital HIV clinic during the year following initiation of a new highly active ART regimen. MEASURES AND MAIN RESULTS: We measured adherence every 4 weeks, computing a composite score from electronic medication bottle caps, pill count and self-report. We evaluated patient demographic, biomedical, and psychosocial characteristics, features of the regimen, and relationship with one’s HIV provider as predictors of adherence over 48 weeks. On average, subjects took 71% of prescribed doses with over 95% of patients achieving suboptimal (<95%) adherence. In multivariate analyses, African-American ethnicity, lower income and education, alcohol use, higher dose frequency, and fewer adherence aids (e.g., pillboxes, timers) were independently associated with worse adherence. After adjusting for demographic and clinical factors, those actively using drugs took 59% of doses versus 72% for nonusers, and those drinking alcohol took 66% of doses versus 74% for nondrinkers. Patients with more antiretroviral doses per day adhered less well. Participants using no adherence aids took 68% of doses versus 76% for those in the upper quartile of number of adherence aids used. CONCLUSIONS: Nearly all patients’ adherence levels were suboptimal, demonstrating the critical need for programs to assist patients with medication taking. Interventions that assess and treat substance abuse and incorporate adherence aids may be particularly helpful and warrant further study.

[1]  J. Cramer,et al.  Cue-dose training with monetary reinforcement , 2000, Journal of General Internal Medicine.

[2]  Seth C. Kalichman,et al.  Adherence to combination antiretroviral therapies in HIV patients of low health literacy , 1999, Journal of General Internal Medicine.

[3]  Paul D. Cleary,et al.  Patients’ trust in their physicians , 1998, Journal of General Internal Medicine.

[4]  Mark V. Williams,et al.  Test of Functional Health Literacy in Adults , 2016 .

[5]  Sherrie H. Kaplan,et al.  Patients’ participation in medical care , 1988, Journal of General Internal Medicine.

[6]  R. Glasgow,et al.  A Social–Ecologic Approach to Assessing Support for Disease Self-Management: The Chronic Illness Resources Survey , 2000, Journal of Behavioral Medicine.

[7]  Lynn Ordway,et al.  Antecedents of adherence to medical recommendations: Results from the medical outcomes study , 1992, Journal of Behavioral Medicine.

[8]  E. Eng,et al.  Secret pills: HIV-positive patients' experiences taking antiretroviral therapy in North Carolina. , 2002, AIDS education and prevention : official publication of the International Society for AIDS Education.

[9]  A. Zolopa,et al.  Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. , 2001, AIDS.

[10]  R. Hays,et al.  A Comparison Study of Multiple Measures of Adherence to HIV Protease Inhibitors , 2001, Annals of Internal Medicine.

[11]  A. Telenti,et al.  Antiretroviral therapies from the patient's perspective , 2000, AIDS care.

[12]  B Clotet,et al.  Prospective Randomized Two‐Arm Controlled Study To Determine the Efficacy of a Specific Intervention To Improve Long‐Term Adherence to Highly Active Antiretroviral Therapy , 2000, Journal of acquired immune deficiency syndromes.

[13]  J. Fleishman,et al.  Prevalence and Predictors of Highly Active Antiretroviral Therapy Use in Patients With HIV Infection in the United States , 2000 .

[14]  J. Fleishman,et al.  Prevalence and predictors of highly active antiretroviral therapy use in patients with HIV infection in the united states. HCSUS Consortium. HIV Cost and Services Utilization. , 2000, Journal of acquired immune deficiency syndromes.

[15]  W. Hauck,et al.  Antiretroviral Use and Pharmacy-Based Measurement of Adherence in Postpartum HIV-Infected Women , 2000, Medical care.

[16]  C. Sherbourne,et al.  Coping, Conflictual Social Interactions, Social Support, and Mood Among HIV-Infected Persons , 2000, American journal of community psychology.

[17]  Susan Swindells,et al.  Adherence to Protease Inhibitor Therapy and Outcomes in Patients with HIV Infection , 2000, Annals of Internal Medicine.

[18]  P D Cleary,et al.  Health-related quality of life in patients with human immunodeficiency virus infection in the United States: results from the HIV Cost and Services Utilization Study. , 2000, The American journal of medicine.

[19]  A. Wu,et al.  Patient-reported nonadherence to HAART is related to protease inhibitor levels. , 2000 .

[20]  A. Wu,et al.  Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG Adherence Instruments , 2000, AIDS care.

[21]  M. Gill,et al.  Long-Term Patient Adherence to Antiretroviral Therapy , 2000, The Annals of pharmacotherapy.

[22]  D. Richman,et al.  Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. , 2000 .

[23]  F. Hecht,et al.  Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population , 2000, AIDS.

[24]  J. Leider,et al.  Understanding Adherence to HIV Medication , 2000, Annals of Internal Medicine.

[25]  K J Roberts,et al.  Barriers to and facilitators of HIV-positive patients' adherence to antiretroviral treatment regimens. , 2000, AIDS patient care and STDs.

[26]  Laura M. Bogart,et al.  Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. , 2000, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[27]  W. Hauck,et al.  Adherence to Antiretroviral Therapy by Pregnant Women Infected With Human Immunodeficiency Virus: A Pharmacy Claims‐Based Analysis , 2000, Obstetrics and gynecology.

[28]  J. Moatti,et al.  Adherence to HAART in French HIV-infected injecting drug users: the contribution of buprenorphine drug maintenance treatment , 2000, AIDS.

[29]  C. Portillo,et al.  The Client Adherence Profiling-Intervention Tailoring (CAP-IT) intervention for enhancing adherence to HIV/AIDS medications: a pilot study. , 2000, The Journal of the Association of Nurses in AIDS Care : JANAC.

[30]  W. Marelich,et al.  Barriers to antiretroviral adherence among HIV-infected adults. , 2000, AIDS patient care and STDs.

[31]  S. Holmberg,et al.  Adherence to antiretroviral medications in an inner-city population. , 1999, Journal of acquired immune deficiency syndromes.

[32]  V. Soriano,et al.  Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. , 1999, AIDS.

[33]  D. Tompkins,et al.  Barriers to adherence to highly active antiretroviral therapy as expressed by people living with HIV/AIDS. , 1999, AIDS patient care and STDs.

[34]  R. Chaisson,et al.  Highly Active Antiretroviral Therapy in a Large Urban Clinic: Risk Factors for Virologic Failure and Adverse Drug Reactions , 1999, Annals of Internal Medicine.

[35]  Robert E. Weiss,et al.  PRESS model selection in repeated measures data , 1999 .

[36]  Richard A. Loftus,et al.  HIV RNA and CD4 cell count response to protease inhibitor therapy in an urban AIDS clinic: response to both initial and salvage therapy. , 1999, AIDS.

[37]  R. Hays,et al.  Psychometric properties of the CAHPS 1.0 survey measures. Consumer Assessment of Health Plans Study. , 1999, Medical care.

[38]  G. Powell-Cope,et al.  Predictors of self-reported adherence in persons living with HIV disease. , 1999, AIDS patient care and STDs.

[39]  A M Zaslavsky,et al.  The relationship between method of physician payment and patient trust. , 1998, JAMA.

[40]  S. Hammer,et al.  The extent of non‐adherence in a large AIDS clinical trial using plasma dideoxynucleoside concentrations as a marker , 1998, AIDS.

[41]  J. Pedro-Botet,et al.  Adherence and effectiveness of highly active antiretroviral therapy. , 1998, Archives of internal medicine.

[42]  D. Richman,et al.  Simultaneous vs sequential initiation of therapy with indinavir, zidovudine, and lamivudine for HIV-1 infection: 100-week follow-up. , 1998, JAMA.

[43]  A. Wu,et al.  Adherence to antiretroviral and pneumocystis prophylaxis in HIV disease. , 1998, Journal of acquired immune deficiency syndromes and human retrovirology : official publication of the International Retrovirology Association.

[44]  S. Hammer,et al.  Antiretroviral therapy for HIV infection in 1997. Updated recommendations of the International AIDS Society-USA panel. , 1998, JAMA.

[45]  E A Emini,et al.  Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. , 1997, The New England journal of medicine.

[46]  J R Ickovics,et al.  Adherence in AIDS clinical trials: a framework for clinical research and clinical care. , 1997, Journal of clinical epidemiology.

[47]  M. Dimatteo,et al.  The Role of Patient Participation in the Doctor Visit: Implications for adherence to diabetes care , 1996, Diabetes Care.

[48]  S. Hammer,et al.  Antiretroviral therapy for HIV infection in 1996. Recommendations of an international panel. International AIDS Society-USA. , 1996, JAMA.

[49]  T. Merigan,et al.  Treatment of human immunodeficiency virus infection with saquinavir, zidovudine, and zalcitabine. AIDS Clinical Trials Group. , 1996, The New England journal of medicine.

[50]  J. Ware,et al.  A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. , 1996, Medical care.

[51]  D. Ho,et al.  A preliminary study of ritonavir, an inhibitor of HIV-1 protease, to treat HIV-1 infection. , 1995, The New England journal of medicine.

[52]  L. M. Lehman,et al.  A short-term study of the safety, pharmacokinetics, and efficacy of ritonavir, an inhibitor of HIV-1 protease. European-Australian Collaborative Ritonavir Study Group. , 1995, The New England journal of medicine.

[53]  J. Condra,et al.  In vivo emergence of HIV-1 variants resistant to multiple protease inhibitors , 1995, Nature.

[54]  S Foundling,et al.  Effect of point mutations on the kinetics and the inhibition of human immunodeficiency virus type 1 protease: relationship to drug resistance. , 1995, Biochemistry.

[55]  I B Duncan,et al.  Characterization of human immunodeficiency virus type 1 mutants with decreased sensitivity to proteinase inhibitor Ro 31-8959. , 1995, Virology.

[56]  G. Parcel,et al.  Zidovudine adherence among individuals with HIV infection. , 1995, AIDS care.

[57]  L. Everitt,et al.  Selection of multiple human immunodeficiency virus type 1 variants that encode viral proteases with decreased sensitivity to an inhibitor of the viral protease. , 1994, Proceedings of the National Academy of Sciences of the United States of America.

[58]  A Morabia,et al.  A cohort study of drug users' compliance with zidovudine treatment. , 1994, Archives of internal medicine.

[59]  D Norbeck,et al.  Characterization of human immunodeficiency virus type 1 variants with increased resistance to a C2-symmetric protease inhibitor , 1994, Journal of virology.

[60]  M. Kuroda,et al.  Generation and characterization of a human immunodeficiency virus type 1 (HIV-1) mutant resistant to an HIV-1 protease inhibitor , 1994, Journal of virology.

[61]  R. Bendayan,et al.  Medication use patterns in HIV-positive patients. , 1993, The Canadian journal of hospital pharmacy.

[62]  R. Street,et al.  Provider-Patient Communication and Metabolic Control , 1993, Diabetes Care.

[63]  R. Elashoff,et al.  Patient Adherence to Cancer Control Regimens: Scale Development and Initial Validation , 1993 .

[64]  D. Kufe,et al.  Compliance with zidovudine therapy in patients infected with human immunodeficiency virus, type 1: a cross-sectional study in a municipal hospital clinic. , 1992, The American journal of medicine.

[65]  C. Sherbourne,et al.  The MOS social support survey. , 1991, Social science & medicine.

[66]  L. Reichman.  Compliance with zidovudine therapy. , 1990, Annals of internal medicine.

[67]  L. Anderson.  Health-Care Communication and Selected Psychosocial Correlates of Adherence in Diabetes Management , 1990, Diabetes Care.

[68]  P. Marantz,et al.  Zidovudine therapy in an inner city population. , 1990, Journal of acquired immune deficiency syndromes.

[69]  J. Cramer,et al.  How often is medication taken as prescribed? A novel assessment technique. , 1989, JAMA.

[70]  R. Sanson-Fisher,et al.  Patient-Provider Interactions and Patient Outcomes , 1989, The Diabetes educator.

[71]  K. Rost.  Influence of Patient Participation on Satisfaction and Compliance , 1989, The Diabetes educator.

[72]  S. Kaplan,et al.  Assessing the Effects of Physician-Patient Interactions on the Outcomes of Chronic Disease , 1989, Medical care.

[73]  K. Rost,et al.  Introduction of information during the initial medical visit: consequences for patient follow-through with physician recommendations for medication. , 1989, Social science & medicine.

[74]  Eliseo J. Perez-Stable,et al.  Development of a Short Acculturation Scale for Hispanics , 1987 .

[75]  M. Stewart,et al.  What is a successful doctor-patient interview? A study of interactions and outcomes. , 1984, Social science & medicine.

[76]  T. Kamarck,et al.  A global measure of perceived stress. , 1983, Journal of health and social behavior.

[77]  R. Brian Haynes,et al.  Compliance in Health Care , 1979 .

[78]  B. Korsch,et al.  Gaps in doctor-patient communication. 1. Doctor-patient interaction and patient satisfaction. , 1968, Pediatrics.