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NRI 97-005 – HSR&D Study

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NRI 97-005
Adherence to Antiretroviral Therapy in HIV Infected Adults
Gail M. Powell-Cope PhD MSN BSN
James A. Haley Veterans' Hospital, Tampa, FL
Tampa, FL
Funding Period: April 1999 - December 2000

BACKGROUND/RATIONALE:
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. In this study, the Theory of Planned Behavior (TPB) is applied to adherence to ART to provide insights into improving adherence. Because few published tools exist to measure beliefs toward ART, this study is a necessary preliminary step to conduct intervention studies.

OBJECTIVE(S):
The objective of this descriptive pilot study was to develop an instrument to measure beliefs and attitudes that predict adherence to ART in HIV-infected adults. Specific aims were to: 1) identify salient beliefs and attitudes about ART adherence through qualitative interviews; 2) develop a quantitative survey instrument to measure beliefs and attitudes about ART; 3) establish content validity of the quantitative survey instrument through reviews by a panel of provider experts and a panel of patients; and 4) pilot test the quantitative instrument to assess test-retest reliability, internal consistency, and preliminary construct validity.

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) was 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 four 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 instrument items.

FINDINGS/RESULTS:
The initial sample was 72 percent male, 38 percent Caucasian, and 64-80 percent 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. 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 medications 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 was pilot tested with 40 patients to evaluate preliminary psychometric properties. Cronbach’s alpha ranged from .86 - .94 across scales and test-retest reliability ranged from .77 - .97. Attitude and Facilitators/Barriers scales were moderately correlated with the Morisky compliance score (r=.41 and .33, respectively).

IMPACT:
From this research, we produced an instrument with strong content validity and preliminary evidence of test-retest reliability, internal consistency and construct validity to measure beliefs, attitudes, barriers and facilitators surrounding compliance to ART. Researchers can use this instrument in testing theory-based interventions to improve adherence to ART in HIV-infected adults.

PUBLICATIONS:
None at this time.


DRA: Health Systems
DRE: none
Keywords: Behavior (patient), HIV/AIDS, Nursing
MeSH Terms: Nursing

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