Factors Associated With Adherence Amongst 5295 People Receiving Antiretroviral Therapy as Part of an International Trial

O'Connor, Jemma; Gardner, Edward M.; Mannheimer, Sharon; Lifson, Alan R.; Eßer, Stefan; Telzak, Edward E.; Phillips, Andrew

doi:10.1093/infdis/jis731

Cited by 74 publications

(79 citation statements)

References 36 publications

(46 reference statements)

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“…In a previous report investigating adherence to anti-retroviral therapy, being prescribed concomitant drugs (i.e. medications for co-morbidities) was one of the independent factors affecting high adherence, which was consistent with the results of our study [37]. The predictors of adherence to extended adjuvant therapy identified in this study were somewhat different to those identified for upfront adjuvant therapy.…”

Section: Discussionsupporting

confidence: 91%

Low Adherence to Upfront and Extended Adjuvant Letrozole Therapy among Early Breast Cancer Patients in a Clinical Practice Setting

Lee

et al. 2014

Oncology

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Objective: The aim of this study was to investigate the prevalence and causes of early discontinuation and non-adherence to upfront and extended adjuvant letrozole therapy in breast cancer patients. Methods: Adherence was assessed using medical charts and longitudinal pharmacy records of 609 patients who initiated adjuvant letrozole between January 2002 and April 2011. A Cox proportional hazards regression model was adopted to identify potential predictors of non-adherence. Results: The overall adherence rate after 1 year of therapy was 79.5%, with cumulative rates declining to 63.7% after 3 years and 57.1% after 5 years. A significantly lower rate of adherence in the extended adjuvant group was observed compared with the upfront adjuvant group (49.0 vs. 72.5%, p < 0.001). Adverse events (50.4%) were the major cause of early discontinuation, with musculoskeletal pain (73.2%) being the single most cited reason. Additional factors correlating with non-adherence in the upfront adjuvant group included a delay in initiation of adjuvant hormone therapy, breast-conserving surgery, calcium supplements, bisphosphonate therapy and concomitant medication for co-morbidity. Conclusions: We observed that approximately 57% of patients fully adhered to letrozole therapy over a 5-year treatment period, and that the adherence to extended letrozole was meaningfully lower than the upfront adjuvant letrozole in a clinical practice setting.

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Section: Discussionsupporting

confidence: 91%

Low Adherence to Upfront and Extended Adjuvant Letrozole Therapy among Early Breast Cancer Patients in a Clinical Practice Setting

Lee

et al. 2014

Oncology

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“…This suggests that what matters is not so much the number of different medications being taken together, rather the number of times each day that medication administration must be coordinated. Other studies looking at management of cardiovascular disease and HIV reach similar conclusions (14)(15)(16)(17)(18). Indeed, one study demonstrated better adherence after adding lipid-lowering treatment to a multidrug treatment regimen in a population with chronic hypertension (19).…”

Section: Discussionmentioning

confidence: 72%

Medication Treatment Complexity and Adherence in Children with CKD

Blydt-Hansen

Pierce

Cai

et al. 2014

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives The complexity of CKD management in children is increased by the number of comorbid conditions. This study assessed the prevalence of comorbidities in pediatric CKD and the frequency with which multiple comorbidities present together by assessing prevalent medication use by CKD stage and diagnosis and their association with clinical or sociodemographic factors. The association between number and frequency of dosing of medications prescribed and self-report of nonadherence was also assessed.Design, setting, participants, & measurements In this cross-sectional analysis of the Chronic Kidney Disease in Children study, medication use at study entry grouped by indication was examined by CKD stage, diagnosis, age, race, ethnicity, income, and CKD duration. Multivariate adjusted predictors of medication use and clustering were examined. Nonadherence was assessed by self-report of missed medications in the past 7 days.Results The 558 eligible participants had a median age of 11 years and median GFR of 44 ml/min per 1.73 m 2 ; 62% of participants were male and 78% had nonglomerular kidney disease. The number of medications for treatment of CKD comorbidities increased with advanced CKD stage (2.5-fold for stages IV versus II; P,0.001) and glomerular disease (1.4-fold versus nonglomerular; P,0.001). Three distinct medication clusters were identified that corresponded to treatment of glomerular disease, advanced renal tubular dysfunction, and proteinuric complications, respectively. Nonadherence was associated with increased medication dosing frequency (administration .2 times/d; P,0.001) but not the number of medications.Conclusions Medical therapy for children with CKD is complex and is affected by glomerular diagnosis, CKD stage, and medication frequency. The need for CKD-related medication treatment cannot be easily predicted by CKD staging alone. Poorer adherence was associated with increased medication frequency, but not with the number of medical problems needing treatment. Consolidating medical treatment and reducing medication frequency may improve adherence rates in children with CKD.

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“…Adherence at each visit was plotted over the first 12 months after ART initiation; during this period, adherence was expected to be documented at 13 visits (2,4,8,12,16,20,24,28,32,36,40,44, 48 weeks post ART initiation). Random effects logistic regression was used to examine the association between CD4 count at initiation and sub-optimal adherence at each visit.…”

Section: Discussionmentioning

confidence: 99%

“…This could have contributed to the poorer adherence seen in men than women in our study. The majority of studies have reported no sex difference with respect to adherence [22][23][24][25][26][27], with one metaanalysis reporting a marginal association of male sex with higher adherence [16].…”

Section: Discussionmentioning

confidence: 99%

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

et al. 2018

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Factors Associated With Adherence Amongst 5295 People Receiving Antiretroviral Therapy as Part of an International Trial

Abstract: In this, the largest analysis of ART adherence to date, some protease inhibitor-containing regimens and regimens with >1 dose per day were associated with suboptimal adherence.

Cited by 74 publications

References 36 publications

Low Adherence to Upfront and Extended Adjuvant Letrozole Therapy among Early Breast Cancer Patients in a Clinical Practice Setting

Low Adherence to Upfront and Extended Adjuvant Letrozole Therapy among Early Breast Cancer Patients in a Clinical Practice Setting

Medication Treatment Complexity and Adherence in Children with CKD

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

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