Evaluation of the Sociodemographic, Behavioral and Clinical Influences on Complete Antiretroviral Therapy Adherence Among HIV-Infected Adults Receiving Medical Care in Houston, Texas

Abstract

Introduction: Few studies have estimated complete antiretroviral therapy (ART) adherence following HIV infection since the advent of the new ART guidelines in 2012. This study determined the prevalence and influence of sociodemographic, behavioral, and clinical factors on complete ART adherence among people living with HIV (PLWH) receiving medical care in Houston/Harris County, Texas. Methods: Data from the Houston Medical Monitoring Project survey collected from 2009 to 2014 among 1073 participants were used in this study. The primary outcome evaluated was combined adherence, defined as complete, partial, and incomplete combined adherence based on three ART adherence types-dose, schedule, and instruction adherence. The duration living since initial HIV diagnosis was classified as <5, 5-10 and >10 years. Rao-Scott Chisquare test and multivariable proportional-odds cumulative logit regression models were employed to identify the sociodemographic, behavioral, and clinical characteristics of complete combined adherence among the three groups of PLWH living with HIV infection. Results: More than one-half (54.4%) of PLWH had complete, 37.4% had partial, and 8.3% had incomplete combined adherence. Among these PLWH, 52.2% had been infected with HIV for >10 years, and 26.5% and 21.4% were infected for <5 years and 5-10 years, respectively. PLWH who were diagnosed <5 and 5-10 years were two times (aOR=1.71, 95% CI=1.13-2.57; aOR=1.69, 95% CI=1.10-2.59; respectively) more likely to experience complete combined adherence than those with >10 years of infection. Multiple sociodemographic, behavioral, and clinical characteristics were significantly associated with complete adherence and varied by the duration of HIV infection. Conclusion:Measures of adherence should include all adherence types (dose, schedule, instruction), as utilizing a single adherence type will overestimate adherence level in PLWH receiving medical care. Intervention efforts to maintain adherence should target recently infected PLWH, while those aimed at improving adherence should focus on longer infected PLWH.

Trajectories of Antiretroviral Therapy Adherence and Virologic Failure in Women With HIV in the United States

“…Previous studies have generally used the conventional approach of dichotomizing adherence or a maximum grouping into 3 levels of adherence. 32 In contrast to our findings, Storholm et al 33 analyzed electronically monitored adherence using the Medication Event Monitoring System in approximately 240 Black PWHIV in the United States at 3 points in time using GBTM. In that analysis, the model revealed 3 adherence trajectories, namely highly stable (40%), moderately low stable (35%), and low decreasing adherence (25%).…”

Dual Trajectories of Antiretroviral Therapy Adherence and Polypharmacy in Women with HIV in the United States

“…In the current analysis, GBTM provided a unique perspective on the evolving nature of WHIV adherence behavior, distinguishing ve categories of adherence across time. Prior studies generally utilized a traditional method of categorizing adherence into two or, at most, three categories, which miss changes in adherence over time [19]. In general, the ndings revealed that most predictors of membership in the continuously low and consistently moderate adherence trajectories (i.e., younger age, being non-Hispanic African American, higher education, any alcohol intake, being on ART for six or more years, and depression) have been described in the literature [20].…”

Unintended Pregnancy and Associated Factors Among Pregnant Women Living With Hiv Bahirdar Town Public Health Facilities, Northwest Ethiopia, 2022

“…The other variable which signi cantly associated with unintended pregnancy was duration of ARV use, which using ARV for more than ve years was associated with more than twice [AOR:2.20, 95% ,CI = 1.28-3.79] higher to have an unintended pregnancy than women who were taking ARV for less than 5 years. It was consistent with the study done in Uganda,which women who have been taking ART drugs for more than 5 years were more likely to had unintended pregnancy as compared to those women who took for less than two years (18).This nding was also supported by a cross-sectional study carried out in America (32) and Malawi (28) which women who were living with HIV for more than ve years and women who were on ART for ≥ 2 years were more likely to experience unintended pregnancy respectively.This could be due to women using ARV for a long time may leads interaction of ARV and anti Tuberclosis medication with contraceptive method so there will be a failure of contraceptive (33).when women takes ARV for long time there will be poor adherence to contraceptive and there will burnout from using ARV drugs daily (34).women may also face problems with HIV-exposed infant because they need special care and attention than the general population.…”