Barriers to Antiretroviral Therapy Adherence and Plasma HIV RNA Suppression Among AIDS Clinical Trials Group Study Participants

Saberi, Parya; Neilands, Torsten B.; Vittinghoff, Eric; Johnson, Mallory O.; Chesney, Margaret A.; Cohn, Susan E.

doi:10.1089/apc.2014.0255

Cited by 29 publications

(33 citation statements)

References 54 publications

(48 reference statements)

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“…Whereas adherence barriers like fear of side effects, pill burden, perceptions that ART is harmful, feeling sick and depressed have been associated with virologic detectability in various AIDS Clinical Trial Participants in United States, current first-line cART comprises low pill burden and improved safety profile with low toxicity [24]. Even if about 89% of women were receiving Efavirenz or Neviparine based regimen, ART regimen type was not significantly associated with virologic detectability.…”

Section: Discussionmentioning

confidence: 96%

Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in the multi-country US-PEPFAR PROMOTE study: A cross-sectional analysis

Atuhaire¹,

Hanley²,

Yende‐Zuma³

et al. 2019

PLoS ONE

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Background Despite recent efforts to scale-up lifelong combination antiretroviral therapy (cART) in sub-Saharan Africa, high rates of unsuppressed viremia persist among cART users, and many countries in the region fall short of the UNAIDS 2020 target to have 90% virally suppressed. We sought to determine the factors associated with unsuppressed viremia (defined for the purpose of this study as >200 copies/ml) among sub-Saharan African women on lifelong cART. Methods This cross-sectional analysis was based on baseline data of the PROMOTE longitudinal cohort study at 8 sites in Uganda, Malawi, Zimbabwe and South Africa. The study enrolled 1987 women living with HIV who initiated lifelong cART at least 1-5 years ago. Socio-demographic, clinical, and cART adherence data were collected. We used multivariable Poisson regression with robust variance to identify factors associated with unsuppressed viremia. Results At enrolment, 1947/1987 (98%) women reported taking cART. Of these, HIV-1 remained detectable in 293/1934 (15%), while 216/1934 (11.2%) were considered unsuppressed (>200 copies/ml). The following factors were associated with an increased risk of

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Section: Discussionmentioning

confidence: 96%

Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in the multi-country US-PEPFAR PROMOTE study: A cross-sectional analysis

Atuhaire¹,

Hanley²,

Yende‐Zuma³

et al. 2019

PLoS ONE

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“…The link between these conditions has been established, 39–41 but the level of impact is not immutable. Interventions to treat clinical depression and simultaneously support adherence with cognitive and behavioral skills can improve both depression and adherence outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Interventions to treat clinical depression and simultaneously support adherence with cognitive and behavioral skills can improve both depression and adherence outcomes. 41 Among patients with opioid dependence, methadone and buprenorphine maintenance can improve medication adherence, and directly administered ART has been associated with improved clinical outcomes among substance abusers. 42 …”

Section: Discussionmentioning

confidence: 99%

Barriers to Universal Prescribing of Antiretroviral Therapy by HIV Care Providers in the United States, 2013–2014

Weiser

Brooks

Skarbinski

et al. 2017

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Introduction HIV treatment guidelines recommend initiating antiretroviral therapy (ART) regardless of CD4 cell (CD4) count, barring contraindications or barriers to treatment. An estimated 6% of persons receiving HIV care in 2013 were not prescribed ART. We examined reasons for this gap in the care continuum. Methods During 2013–2014, we surveyed a probability sample of HIV care providers, of whom 1234 returned surveys (64.0% adjusted response rate). We estimated percentages of providers who followed guidelines and their characteristics, and who deferred ART prescribing for any reason. Results Barring contraindications, 71.2% of providers initiated ART regardless of CD4 count. Providers less likely to initiate had caseloads ≤20 vs. >200 patients [adjusted prevalence ratios (aPR) 0.69, 95% confidence interval (CI): 0.47 to 1.02, P = 0.03], practiced at non–Ryan White HIV/AIDS Program-funded facilities (aPR 0.85, 95% CI: 0.74 to 0.98, P = 0.02), or reported pharmaceutical assistance programs provided insufficient medication to meet patients’ needs (aPR 0.79, 95% CI: 0.65 to 0.98, P = 0.02). In all, 17.0% never deferred prescribing ART, 69.6% deferred for 1%–10% of patients, and 13.3% deferred for >10%. Among providers who had deferred ART, 59.4% cited patient refusal as a reason in >50% of cases, 31.1% reported adherence concerns because of mental health disorders or substance abuse, and 21.4% reported adherence concerns because of social problems, eg, homelessness, as factors in >50% of cases when deferring ART. Conclusions An estimated 29% of HIV care providers had not adopted recommendations to initiate ART regardless of CD4 count, barring contraindications, or barriers to treatment. Low-volume providers and those at non–Ryan White HIV/AIDS Program-funded facilities were less likely to follow this guideline. Among all providers, leading reasons for deferring ART included patient refusal and adherence concerns.

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“…50 Qualitative studies have identified a number of patient-reported barriers to adherence, including forgetfulness, limited understanding of the importance of treatment, drug side effects, pill burden, disruptions to daily routine, and competing priorities. 51 Some studies have reported that feeling sick is a more frequent barrier to adherence than feeling healthy 52 ; this may in part be related to the higher pill burden associated with the treatment of comorbodities. 53 The relationship between baseline CD4 count and adherence to ART is complex and contextual, and other factors are likely as important or more important in determining adherence, as suggested by the variability in adherence levels between studies included in this review.…”

Section: Discussionmentioning

confidence: 99%

Baseline CD4 Count and Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis

Böck

James

Nikuze

et al. 2016

JAIDS Journal of Acquired Immune Deficiency Syndromes

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Barriers to Antiretroviral Therapy Adherence and Plasma HIV RNA Suppression Among AIDS Clinical Trials Group Study Participants

Abstract: We conducted a secondary data analysis of 11 AIDS Clinical

Cited by 29 publications

References 54 publications

Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in the multi-country US-PEPFAR PROMOTE study: A cross-sectional analysis

Factors associated with unsuppressed viremia in women living with HIV on lifelong ART in the multi-country US-PEPFAR PROMOTE study: A cross-sectional analysis

Barriers to Universal Prescribing of Antiretroviral Therapy by HIV Care Providers in the United States, 2013–2014

Baseline CD4 Count and Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis

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