Patient and Regimen Characteristics Associated with Self-Reported Nonadherence to Antiretroviral Therapy

Abstract

BackgroundNonadherence to antiretroviral therapy (ARVT) is an important behavioral determinant of the success of ARVT. Nonadherence may lead to virological failure, and increases the risk of development of drug resistance. Understanding the prevalence of nonadherence and associated factors is important to inform secondary HIV prevention efforts.Methodology/Principal FindingsWe used data from a cross-sectional interview study of persons with HIV conducted in 18 U.S. states from 2000–2004. We calculated the proportion of nonadherent respondents (took <95% of prescribed doses in the past 48 hours), and the proportion of doses missed. We used multivariate logistic regression to describe factors associated with nonadherence. Nine hundred and fifty-eight (16%) of 5,887 respondents reported nonadherence. Nonadherence was significantly (p<0.05) associated with black race and Hispanic ethnicity; age <40 years; alcohol or crack use in the prior 12 months; being prescribed ≥4 medications; living in a shelter or on the street; and feeling “blue” ≥14 of the past 30 days. We found weaker associations with having both male-male sex and injection drug use risks for HIV acquisition; being prescribed ARVT for ≥21 months; and being prescribed a protease inhibitor (PI)-based regimen not boosted with ritonavir. The median proportion of doses missed was 50%. The most common reasons for missing doses were forgetting and side effects.Conclusions/SignificanceSelf-reported recent nonadherence was high in our study. Our data support increased emphasis on adherence in clinical settings, and additional research on how providers and patients can overcome barriers to adherence.

Differential Predictors of Medication Adherence in HIV: Findings from a Sample of African American and Caucasian HIV-Positive Drug-Using Adults

“…Overall, African Americans demonstrated lower rates of medication adherence over the course of the study, which is consistent with other studies examining ethnic differences in HIV medication adherence. [55][56][57] Results of previous studies assessing racial differences in HIV medication adherence have focused on socioeconomic factors that may moderate this relationship. However, there is more recent evidence to suggest that these factors alone do not eliminate disparities between racial groups on medication adherence.…”

Impact of HIV-Specialized Pharmacies on Adherence and Persistence with Antiretroviral Therapy

“…12 Knobel et al 13 found that only 33% of patients in their study were able to maintain an adherence level of at least 90% and in a study by Shuter et al, 7 patients experienced an average adherence rate of 73%. Several factors can impact a patient's adherence and persistence with antiretroviral therapy, including relationship with/trust in provider, 14 lack of social support, 14,15 regimen complexity, 16,17 and misunderstanding of the disease and drug treatment. 18 To address these barriers to adherence, select pharmacies have implemented specialized services for HIV patients within traditional community pharmacies.…”

Differences in Patient–Provider Communication for Hispanic Compared to Non-Hispanic White Patients in HIV Care

“…[1][2][3][4] The underlying causes of these disparities are unclear but are probably manifold. One potential factor that has not been well studied is the role of communication barriers between patients and providers.…”