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128. Adherence to Antiretroviral Therapy in HIV-Infected Adults

G Powell-Cope, James A. Haley VA Hospital; D Dontano, Battelle

Objectives: Clinicians and researchers in the field of HIV agree that adherence to antiretroviral therapy (ART) is a major challenge in the ability to control HIV infection due to the relationship between adherence and viral suppression. This study builds on a body of literature about medication adherence and the Theory of Planned Behavior (TPB), a theory, which has been extensively tested in health-related behaviors. In this study, the TPB is applied to adherence to ART to provide insights into improving adherence.

The objective of this descriptive pilot study is to develop an instrument with strong content validity, test-retest reliability, internal consistency reliability, and preliminary construct validity to measure beliefs and attitudes that predict adherence to ART in HIV-infected adults. Ultimately we will design a study to test interventions targeting beliefs, attitudes and barriers to increase adherence to ART.

Methods: Phase one employed a descriptive design using semi-structured interviews. A purposive sample of 90 subjects (balanced by low/high adherence, gender, and ethnicity-white, black, Hispanic) were recruited from one VA clinic and three non-VA clinics. Inclusion criteria were: over age 18; English speaking; no significant cognitive impairment; and on ART for at least 4 weeks. Data collectors were trained regarding interviewing techniques, data management, and data analysis. After informed consent, subjects were interviewed in person using a semi-structured interview schedule. Audiotapes of interviews were transcribed. Transcripts were content analyzed to identify the most frequently reported positive and negative beliefs, social influences toward ART, and barriers and facilitators to ART use. The most salient beliefs were constructed into belief instrument items.

Results: The sample was 72% male, 38% Caucasian, and 64-80% compliant (by provider and self-report, respectively). The most frequently reported positive beliefs about the outcomes of antiretroviral therapy were a lengthened life, improved health and improved quality of life. Only four respondents directly reported prevention of drug resistance as a benefit of compliance. Frequently reported negative beliefs were side effects, dietary restrictions, and inconvenience. Barriers to compliance were alcohol or drug use, work or school schedule, being too busy, and a general dislike of taking medications. Frequently reported facilitators of taking mediations were having a stable work, school or sleep routine, reminder systems, and having the medications on hand when away from home. The most frequently reported beliefs were used to construct questionnaire items for a survey instrument to measure attitudes about ART. The questionnaire was evaluated for content, semantics and clarity by a subset of 20 subjects from the original sample, and 15 nurses and physicians in HIV care. In the final phase of instrument development, the questionnaire is being pilot tested with 30 patients to evaluate preliminary psychometric properties.

Conclusions: From this research, we produced an instrument with strong content validity to measure beliefs about ART. We expect to show preliminary evidence of construct validity.

Impact: This instrument can be used to obtain information essential to the design of theory-based interventions to improve adherence to ART in HIV-infected adults, and to evaluate the effectiveness of those interventions.