Medication adherence challenges among patients experiencing homelessness in a behavioral health clinic

Abstract

Background Behavioral health medication nonadherence is associated with poor health outcomes and increased healthcare costs. Little is known about reasons for nonadherence with behavioral health medications among homeless people. Objectives To identify reasons for medication nonadherence including the sociodemographic, health-related factors, and behavioral health conditions associated with medication nonadherence among behavioral health patients served by a Health Care for the Homeless center (HCH) in Virginia. Methods The study sample was selected from an existing database that included sociodemographic, health-related information, and medication-related problems identified during a pharmacist-provided medication review conducted during October 2008–September 2009. Patients experiencing or at risk of homelessness who were ≥ 18 years old with at least one behavioral health condition who had a medication review were eligible for the study. A qualitative content analysis of the pharmacist documentation describing the patient’s reason(s) for medication nonadherence was conducted. The Behavioral Model for Vulnerable Populations was the theoretical framework. The outcome variable was self-reported medication nonadherence. Descriptive and multivariate (logistic regression) statistics were used. Results A total of 426 individuals met study criteria. The mean age was 44.7 ± 10.2 years. Most patients were African-American (60.5%) and female (51.6%). The content analysis identified patient-related factors (74.8%), therapy-related factors (11.8%), and social or economic factors (8.8%) as the most common reasons for patients’ medication nonadherence. Patients with post-traumatic stress disorder (PTSD) (adjusted odds ratio: 0.4; 95% CI: 0.19–0.87) were less likely to have a medication adherence problem identified during the medication review. Conclusions The content analysis identified patient-related factors as the most common reason for nonadherence with behavioral health medications. In the quantitative analysis, patients with a PTSD diagnosis were less likely to have nonadherence identified which may be related to their reluctance to self-report nonadherence and their diagnosis, which warrants further study.

Longer duration of homelessness is associated with a lower likelihood of non-detectable plasma HIV-1 RNA viral load among people who use illicit drugs in a Canadian setting

“…Although the link between homelessness and the risk of sub-optimal HAART adherence is well established, the effect of the duration of homelessness on VL dynamics among people living with HIV/AIDS has not been well explored (Coe et al, 2015; Waldrop-Valverde & Valverde, 2005). We have previously described how periods of homelessness are associated with lower likelihoods of optimal adherence, and how homelessness is a structural barrier to virologic response among individuals initiating HAART (Milloy, Kerr, Bangsberg, et al, 2012; Palepu, Milloy, Kerr, Zhang, & Wood, 2011).…”

Global implementation of PrEP as part of combination HIV prevention - Unsolved challenges

“…Risk assessment tools relying on selfreported risk behaviours to estimate HIV risk have been successfully implemented among MSM [44] and PWID [45]. Applying algorithms to routinely collect behavioural or STI history data from patients' electronic health records provides additional support in this task [46].…”

“…Estimates of new HIV infections occurring within stable, heterosexual partnerships in Africa range from 30 to 60% [39Á44]. WHO has provided guidance on use of PrEP for sero-discordant couples since 2013 [45,46], but the extent to which this has been incorporated into national guidelines across Africa is not clear. Identifying sero-discordant couples is critical as it allows for a range of treatment and prevention interventions, including those to allow safe conception [47] and to prevent transmission in pregnancy, tailored to the couple's particular situation.…”

“…In some countries, such as Myanmar [45], Cambodia [46] and the Philippines [47], old punitive laws are still in action. As a result, stigma and discrimination against marginalized groups remain common barriers to PrEP implementation.…”

“…Contextually situated psychosocial drivers of HIV risk among many trans women are more similar to those of non-trans women than those of men. These psychosocial drivers include experiences of trauma, domestic and sexual violence, misogyny, survival sex work, sexual objectification and unequal power in relationships to negotiate safer sex [37,38,45,46].…”