Factors Associated with Complete Adherence to HIV Combination Antiretroviral Therapy

Juday, Timothy; Gupta, Shaloo; Grimm, Kristy; Wagner, Samuel C.; Kim, Edward

doi:10.1310/hct1202-71

Cited by 53 publications

(41 citation statements)

References 17 publications

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“…Similar to previous studies,4 20 we found that patients who were adherent to therapy were less likely to be hospitalised. Our data demonstrated similar rates of hospitalisations among patients with the highest levels of complete adherence—at least 95%.…”

Section: Discussionsupporting

confidence: 90%

Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV

2013

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ObjectivesLower pill burden leads to improved antiretroviral therapy (ART) adherence among HIV patients. Simpler dosing regimens have not been widely explored in real-world populations. We retrospectively assessed ART adherence, all-cause hospitalisation risk and costs, and other healthcare utilisation and costs in Medicaid enrollees with HIV treated with ART as a once-daily single-tablet regimen (STR) or two or more pills per day (2+PPD).DesignPatients with an HIV diagnosis from 2005 to 2009 receiving complete ART (ie, two nucleoside/nucleotide reverse transcriptase inhibitors plus a third agent) for ≥60 days as STR or 2+PPD were selected and followed until the first of (1) discontinuation of the complete ART, (2) loss of enrolment or (3) end of database. Adherence was measured using the medication possession ratio. Monthly all-cause healthcare utilisation and costs were observed from regimen initiation until follow-up end.ResultsOf the 7381 patients who met inclusion criteria, 1797 were treated with STR and 5584 with 2+PPD. STR patients were significantly more likely to reach 95% adherence and had fewer hospitalisations than 2+PPD patients (both p<0.01). STR patients had mean (SD) total monthly costs of $2959 ($4962); 2+PPD patients had $3544 ($5811; p<0.001). Hospital costs accounted for 53.8% and pharmacy costs accounted for 32.5% of this difference. Multivariate analyses found that STR led to a 23% reduction in hospitalisations and a 17% reduction in overall healthcare costs. ART adherence appears to be a key mechanism mediating hospitalisation risk, as patients with ≥95% adherence (regardless of regimen type) had a lower hospitalisation rate compared with <95% adherence.ConclusionsWhile it was expected that STR patients would have lower pharmacy costs, we also found that STR patients had fewer hospitalisations and lower hospital costs than 2+PPD patients, resulting in significantly lower total healthcare costs for STR patients.

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Section: Discussionsupporting

confidence: 90%

Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV

2013

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“…Although these studies were not included, the general trend of these adherence results was consistent with those of the present analysis. Furthermore, the present results of better adherence and efficacy with fixed-dose combination therapy are supported by results from other therapeutic classes including antihypertensive agents, antiretroviral therapies for HIV, and lipid-modifying therapies [37][38][39] .…”

Section: Discussionmentioning

confidence: 60%

Glycemic effectiveness and medication adherence with fixed-dose combination or coadministered dual therapy of antihyperglycemic regimens: a meta-analysis

Han

Iglay

Davies

et al. 2012

Current Medical Research and Opinion

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“…Fielden et al 18 and Juday et al 19 have found that adherence is a key factor in decreasing the risk of hospitalisation. In this study poor adherence to antiretroviral treatment was not an independent predictor.…”

Section: Discussionmentioning

confidence: 99%

Design and validation of a predictive model for 1-year hospital admission in HIV patients on antiretroviral treatment

et al. 2016

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ObjectivesTo develop and validate a model for predicting the risk of hospital admission within 1 year in the HIV population under antiretroviral treatment.MethodsWe conducted a retrospective observational study. Patients receiving antiretroviral treatment for at least 1 year who were followed by the pharmacy service in a Spanish-speaking hospital between January 2008 and December 2012 were included. Demographics, and clinical and pharmacotherapy variables, were included in the model design. To find prognostic factors for hospital admission a multivariate logistic regression model was created after performing a univariate analysis. Model validity was determined by the shrinkage method and the model discrimination by Harrell's C-index.Results442 patients were included in the study. The variables ‘CD4 count <200 (cells/µL)’, ‘drug/alcohol use’, ‘detectable viral load (>50 copies/mL)’, ‘number of previous admissions’, and ‘number of drugs different from antiretroviral treatment’ were the independent predictors of risk of hospital admission. Probabilities predicted by the model showed an R2=0.98 for the development sample and an R2=0.86 for the validation sample. The Harrell's C index for the development and validation data were 0.82 (95% CI 0.77 to 0.87) and 0.80 (95% CI 0.73 to 0.88), respectively.ConclusionsThe model developed in this study may be useful in daily practice for identifying HIV patients at high risk of 1-year hospital admission.

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Factors Associated with Complete Adherence to HIV Combination Antiretroviral Therapy

Abstract: This study shows the negative impact of higher pill burden on medication adherence, an important factor associated with treatment outcomes in patients with HIV/AIDS.

Cited by 53 publications

References 17 publications

Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV

Association between daily antiretroviral pill burden and treatment adherence, hospitalisation risk, and other healthcare utilisation and costs in a US medicaid population with HIV

Glycemic effectiveness and medication adherence with fixed-dose combination or coadministered dual therapy of antihyperglycemic regimens: a meta-analysis

Design and validation of a predictive model for 1-year hospital admission in HIV patients on antiretroviral treatment

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