Factors Influencing Medication Adherence Beliefs and Self-Efficacy in Persons Naive to Antiretroviral Therapy: A Multicenter, Cross-Sectional Study

Abstract

It is widely recognized that adherence to antiretroviral therapy is critical to long-term treatment success, yet rates of adherence to antiretroviral medications are frequently subtherapeutic. Beliefs about antiretroviral therapy and psychosocial characteristics of HIV-positive persons naive to therapy may influence early experience with antiretroviral medication adherence and therefore could be important when designing programs to improve adherence to antiretroviral therapy. As part of a multicenter AIDS Clinical Trial Group (ACTG 384) study, 980 antiretroviral-naive subjects (82% male, 47% White, median age 36 years, and median CD4 cell count 278 cells/mm3) completed a self-administered questionnaire prior to random treatment assignment of initial antiretroviral medications. Measures of symptom distress, general health and well-being, and personal and situational factors including demographic characteristics, social support, self-efficacy, depression, stress, and current adherence to (nonantiretroviral) medications were recorded. Associations among variables were explored using correlation and regression analyses. Beliefs about the importance of antiretroviral adherence and ability to take antiretroviral medications as directed (adherence self-efficacy) were generally positive. Fifty-six percent of the participants were "extremely sure" of their ability to take all medications as directed and 48% were "extremely sure" that antiretroviral nonadherence would cause resistance, but only 37% were as sure that antiretroviral therapy would benefit their health. Less-positive beliefs about antiretroviral therapy adherence were associated with greater stress, depression, and symptom distress. More-positive beliefs about antiretroviral therapy adherence were associated with better scores on health perception, functional health, social-emotional-cognitive function, social support, role function, younger age, and higher education (r values = 0.09-0.24, all p < .001). Among the subset of 325 participants reporting current use of medications (nonantiretrovirals) during the prior month, depression was the strongest correlate of nonadherence ( r = 0.33, p < .001). The most common reasons for nonadherence to the medications were "simply forgot" (33%), "away from home" (27%), and "busy" (26%). In conclusion, in a large, multicenter survey, personal and situational factors, such as depression, stress, and lower education, were associated with less certainty about the potential for antiretroviral therapy effectiveness and one's perceived ability to adhere to therapy. Findings from these analyses suggest a role for baseline screening for adherence predictors and focused interventions to address modifiable factors placing persons at high risk for poor adherence prior to antiretroviral treatment initiation.

Individualised patient care as an adjunct to standard care for promoting adherence to ocular hypotensive therapy: an exploratory randomised controlled trial

“…Beliefs about illness and medicines have been widely researched in chronic disease, [29][30][31][32] but not until recently in glaucoma. A cross-sectional survey of glaucoma patients, which incorporated the Brief IPQ 33 and the BMQ, 18 found as we did that patients with poor adherence had more concerns and less belief in the necessity of drops.…”

HIV/AIDS-related stigma in Kumasi, Ghana

“…Community members may not seek VCT because of the fear of discovering that they are HIV positive and fear of the resulting stigma and discrimination that may accompany their HIV/AIDS positive status. Thus, HIV/AIDS related stigma and discrimination may have a profound impact on the disclosure (revelation) of HIV status and the subsequent care, support, or treatment that HIV positive persons receive , Muyinda, et al 1997, Weiss and Ramakrishna 2001, Mill 2003, Carr and Gramling 2004, Reynolds, et al 2004. In Ghana, HIV positive persons hide their HIV-seropositive status to reduce HIV/AIDS related stigma and discrimination and to retain the care and support of family members.…”

“…Ironically, this secrecy hinders uptake of treatment and of support services that can be provided by family members (Mill 2003). People who feel stigmatized or discriminated against are more likely to have poor health outcomes, socio-psychological problems, and suicidal thoughts , Reynolds, et al 2004, Bottonari, et al 2005, Katz and Nevid 2005, Sledjeski, et al 2005. Tackling HIV stigma will involve tackling perceptions and values towards sexuality and HIV/AIDS.…”

Preliminary survey of educational support for patients prescribed ocular hypotensive therapy

“…Younger patients appear to live more active lifestyles and spend periods of time away from home, or are involved in different activities leading them to forget medication when out of their normal routine. Studies involving patients with chronic diseases, such as diabetes 51 and HIV, 52 found that poor adherence arose as patients had difficulties changing their lifestyle to integrate a therapeutic regimen. As we also found, forgetfulness is frequently cited as a reason for poor adherence 20,37,[53][54][55] ; an intervention incorporating reminder systems into daily activities may prove advantageous.…”