Patient Characteristics and Attitudes Associated with Antiretroviral (AR) Adherence

Wenger N, Gifford AL, Liu H, Chesney MA, Golin C, Crystal S, Berry S, Coplan P, Bozzette SA, Shapiro MF. Patient Characteristics and Attitudes Associated with Antiretroviral (AR) Adherence. Paper presented at: Retroviruses and Opportunistic Infections Annual Conference; 1999 Feb 1; Chicago, IL.

Long-term adherence to AR regimens is critical to survival with HIV. We evaluated AR-specific adherence over the past 7 days reported in the HIV Cost and Services Utilization Study, a nationally representative probability sample of persons receiving HIV care. This analysis focuses on the 1910 (84%) subjects taking AR among 2267 participating in a Sept to Dec 1997 interview (92% response rate), and uses baseline sample weights to adjust for sampling, multiplicity and non-response. Over the past 7 days, 57% reported taking all ARs as directed, 32% adhered on 5-6 days, and 11% on < 4 days. Bivariate analyses of adhering to all ARs for the past 7 days revealed: older individuals (70% of > 50yo v. 59% of 35-49yo v. 50% of 18-34yo, p < .0001), men (60% v. 49% of women, p = .008), Whites (63% v. 53% of African-Americans v. 47% of Hispanics, p = .0001) and insured persons (64% Medicare v. 62% private v. 55% no insurance v. 49% Medicaid, p = 0.01) were more likely to report adherence. Heavy alcohol and drug users adhered less (45% v. 59%, p = .0003). Adherence increased with the number of ARs in regimen and with more AR pills prescribed per day (1-10 pills 53%, 11-20 pills 61%, > 20 pills 59%). Adherence was higher if subjects reported medication fit into their daily schedule (32% not at all, 46% a little, 50% somewhat, 63% very, 67% extremely well, p < .0001) and if subjects perceived ARs to be effective and that non-adherence would lead to viral resistance (strongly agree 64%, agree 56%, disagree 50%, strongly disagree 43%, p < .0001). Patient characteristics, fit of AR with daily routine and attitudes about ARs are strongly related to AR adherence whereas AR regimen factors may be less relevant. Interventions to improve adherence should target these groups and factors