Patterns of Adherence to Antiretrovirals: Why Adherence Has No Simple Measure

Abstract

The goal of this study was to explore patterns and explanations of adherence to antiretroviral therapies from the patient's perspective. It consisted of 78 in-depth interviews with patients attending an HIV clinic in New Orleans, Louisiana, to whom combination therapy had been prescribed. Interviews explored patient's definitions of adherence, beliefs about consequences of nonadherence, reasons for current and past adherence behavior, and contextual issues such as drug and alcohol use and social support. Respondents reported nine distinct patterns of adherence, which they perceived to have different consequences and causes. These patterns hid variations because respondents could have more than one pattern simultaneously and patterns were not stable over time. Although there are gold standards for adherence measurement, such as directly observed therapy, these measurements are most frequently used to classify respondents as adherers or nonadherers based on whether they take a certain percentage of their medication. Such a categorization is simplistic and does not reflect the complexity of adherence patterns.

Reasons for ART non-adherence in the Deep South: Adherence needs of a sample of HIV-positive patients in Mississippi

“…Possibly, 'feeling sick' contributed to women's decision to stop their medication; however, further research is required to determine that potential relationship. Finally, similar to previous studies with Deep South, HIV-positive populations (Ferguson et al, 2002;Hill et al, 2003) women endorsed not wanting others to see them taking their ART medications more than men (22 versus 3%). Addressing these kinds of concerns and potentially their association with HIV-related stigma may be particularly important when working with HIV-positive women from this geographic region.…”

“…However, 'not wanting others to see me taking my medications' was less frequently endorsed (11%) in the current sample than in past research (e.g. Ferguson et al, 2002;Hill et al, 2003;Kalichman et al, 1999).…”

HIV Medication Adherence and Substance Use: The Smartest Women’s Project

“…Other measures of adherence, such as electronic drug monitoring or pill counts would provide additional supportive data. Although self-report measures are useful for assessing non-adherence [1,26] , many participants, particularly current substance users, tend to overestimate their adherence level with self-report measures [1,35] or may not consider themselves nonadherent when they modify their own regimen [36] .Overestimation as a consequence of current substance use may also explain the high levels of selfefficacy endorsed by current users at baseline, comparable to the alcoholic's estimation of their driving skills while "under the influence".…”

An investigation of the determinants of adherence to highly active anti-retroviral therapy in Aboriginal men in the Downtown Eastside of Vancouver.

“…Studies indicate that procrastination and being too distracted or busy can lead to low HAART adherence (Hill, Kendall, & Fernandez, 2003;Powell-Cope et al, 2003;Westerfelt, 2004). One may procrastinate or be too busy or distracted due to work and/ or because they are searching for money to buy daily needs, among other reasons.…”