Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: a prospective study.

BACKGROUND We examined adherence to highly active antiretroviral therapy (HAART) in the homeless population, a population thought to be at high risk for poor adherence to therapy and for development of drug-resistant strains of human immunodeficiency virus (HIV). METHODS We performed a 12-month prospective study of 148 persons receiving HAART who were identified in a stratified screening of the homeless and marginally housed. We sampled in lunch lines, shelters, and hotels in 3 neighborhoods of San Francisco, California. We used pill counts at unannounced home visits as the primary measure of adherence. RESULTS Of 148 individuals sampled, 46 (31%) discontinued HAART during the study. Average adherence in the group of those who discontinued HAART was 51%, and 9% of these subjects had undetectable virus loads (i.e., <400 copies/mL) at the last follow-up visit. Predictors of discontinuation of therapy were depressive symptoms, injection drug use, African American ethnicity, and early poor adherence. Of 148 subjects, 102 (69%) continued to receive HAART throughout the study period. Average adherence in the group of those who continued to receive HAART was 74%, and 55% of these subjects had undetectable virus loads at the last follow-up visit. Predictors of lower average adherence in this group were African American ethnicity and use of crack cocaine; men who had sex with men had higher adherence. CONCLUSIONS One-third of homeless and marginally housed persons receiving HAART discontinued therapy during the follow-up period and would benefit from adherence interventions directed at sustaining therapy; two-thirds continued to receive therapy at adherence levels comparable to those found with other clinical populations.

[1]  D. Bangsberg,et al.  HIV seroprevalence among homeless and marginally housed adults in San Francisco. , 2004, American journal of public health.

[2]  A. d’Arminio Monforte,et al.  Medication adherence among HIV+ adults: Effects of cognitive dysfunction and regimen complexity , 2003, Neurology.

[3]  A. Zolopa,et al.  High levels of adherence do not prevent accumulation of HIV drug resistance mutations , 2003, AIDS.

[4]  Jerome H. Carter,et al.  Duration of highly active antiretroviral therapy regimens. , 2003, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[5]  F. Mulcahy,et al.  Assessing limiting factors to the acceptance of antiretroviral therapy in a large cohort of injecting drug users , 2003, HIV medicine.

[6]  C. Hinkin,et al.  Medication adherence among HIV+ adults , 2002, Neurology.

[7]  A. Wu,et al.  Depression Is a Risk Factor for Suboptimal Adherence to Highly Active Antiretroviral Therapy , 2002, Journal of acquired immune deficiency syndromes.

[8]  J. Chmiel,et al.  Durability and predictors of success of highly active antiretroviral therapy for ambulatory HIV-infected patients , 2002, AIDS.

[9]  Elizabeth Connick,et al.  Antiretroviral-drug resistance among patients recently infected with HIV. , 2002, The New England journal of medicine.

[10]  D. Vlahov,et al.  A PROSPECTIVE STUDY OF ADHERENCE AND VIRAL LOAD IN A LARGE MULTI-CENTER COHORT OF HIV-INFECTED WOMEN , 2002, AIDS.

[11]  B. Yip,et al.  Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up , 2002, AIDS.

[12]  D. Bangsberg,et al.  Emergency department use among the homeless and marginally housed: results from a community-based study. , 2002, American journal of public health.

[13]  R. Grant,et al.  Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. , 2002 .

[14]  M. Chesney,et al.  The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus-infected persons in clinical trials. , 2002, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[15]  John A. Bartlett,et al.  Addressing the Challenges of Adherence , 2002, Journal of acquired immune deficiency syndromes.

[16]  Marilyn M. Wagener,et al.  Adherence to protease inhibitor therapy and outcomes in patients with HIV infection (vol 133, pg 21, 2000) , 2002 .

[17]  Sundhiya Mandalia,et al.  Responses to a 1 month self-report on adherence to antiretroviral therapy are consistent with electronic data and virological treatment outcome , 2002, AIDS.

[18]  W. Bilker,et al.  Effect of adherence to newly initiated antiretroviral therapy on plasma viral load , 2001, AIDS.

[19]  R. Grant,et al.  Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[20]  F. Hecht,et al.  Comparing Objective Measures of Adherence to HIV Antiretroviral Therapy: Electronic Medication Monitors and Unannounced Pill Counts , 2001, AIDS and Behavior.

[21]  D. Nicolau,et al.  Adherence to highly active antiretroviral therapy predicts virologic outcome at an inner-city human immunodeficiency virus clinic. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[22]  R. Steketee,et al.  HIV in the United States at the turn of the century: an epidemic in transition. , 2001, American journal of public health.

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

[24]  D. Bangsberg,et al.  Expanding directly observed therapy: tuberculosis to human immunodeficiency virus. , 2001, The American journal of medicine.

[25]  J. Hackman,et al.  A randomized, controlled trial of interventions to improve adherence to isoniazid therapy to prevent tuberculosis in injection drug users. , 2001, The American journal of medicine.

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

[27]  D. Vlahov,et al.  Mortality, CD4 cell count decline, and depressive symptoms among HIV-seropositive women: longitudinal analysis from the HIV Epidemiology Research Study. , 2001, JAMA.

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

[29]  J. Fleishman,et al.  Prevalence and Predictors of Highly Active Antiretroviral Therapy Use in Persons with HIV Infection in the U.S , 2000 .

[30]  M. Dimatteo,et al.  Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. , 2000, Archives of internal medicine.

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

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

[33]  M. Chesney,et al.  Adherence to isoniazid prophylaxis in the homeless: a randomized controlled trial. , 2000, Archives of internal medicine.

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

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

[36]  H. Wineberg Oregon's Death with Dignity Act: fourteen months and counting. , 2000, Archives of internal medicine.

[37]  P. Volberding,et al.  Adherence communication: a qualitative analysis of physician-patient dialogue. , 1999, AIDS.

[38]  J E Ware,et al.  Overview of the SF-36 Health Survey and the International Quality of Life Assessment (IQOLA) Project. , 1998, Journal of clinical epidemiology.

[39]  B. Yip,et al.  Barriers to use of free antiretroviral therapy in injection drug users. , 1998, JAMA.

[40]  P. Kissinger,et al.  Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. , 1998, The New England journal of medicine.

[41]  J. Kahn,et al.  Sexual transmission of an HIV-1 variant resistant to multiple reverse-transcriptase and protease inhibitors. , 1998, The New England journal of medicine.

[42]  T. Wall,et al.  Medication adherence strategies for drug abusers with HIV/AIDS. , 1998, AIDS care.

[43]  G. Satten,et al.  Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. , 1998, The New England journal of medicine.

[44]  F. Hecht,et al.  Protease inhibitors in the homeless. , 1997, JAMA.

[45]  T. Frieden,et al.  Tuberculosis in New York City--turning the tide. , 1995, The New England journal of medicine.

[46]  A. Zolopa,et al.  HIV and tuberculosis infection in San Francisco's homeless adults. Prevalence and risk factors in a representative sample. , 1994, JAMA.

[47]  R. Chaisson,et al.  Racial differences in the use of drug therapy for HIV disease in an urban community. , 1994, The New England journal of medicine.

[48]  P. Koegel,et al.  Methodology for Obtaining a Representative Sample of Homeless Persons , 1988 .

[49]  Rachel U Lee,et al.  Third regional audit of antiretroviral prescribing in HIV patients. , 2003, International journal of STD & AIDS.

[50]  R. Grant,et al.  Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users , 2002, Journal of General Internal Medicine.

[51]  A. Beck,et al.  Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation , 1988 .