Prevalence, Predictors, and Outcomes of Early Adherence after Starting or Changing Antiretroviral Therapy

Abstract

The objectives of this research were to assess prevalence and predictors of early antiretroviral therapy adherence using multiple indicators and to estimate effects of early adherence on subsequent HIV viral load and CD4+ lymphocyte responses. Study subjects were adults with HIV infection referred to an antiretroviral therapy-monitoring clinic for initiation or change in therapy between March 1998 and June 1999. The design was a prospective observational cohort involving baseline interview followed by 30 days of electronic adherence monitoring (MEMS), 30-day interview, and follow-up viral load at 1, 3, and 6 months. Adherence indicators included MEMS therapeutic coverage, observed/expected cap openings, and self-reported adherence assessed at 30 days. Of 235 consenting patients, 60 (26%) failed to complete 30 days of electronic monitoring (noncompleters). At 6 months, mean change from baseline plasma viral load was inferior among noncompleters (0.5 log vs. 1.7 log). Predictors of adherence, varying by adherence metric, included: gender, race, prior antiretroviral therapy experience, substance abuse, prior adherence behavior, health beliefs, and pharmacist prediction of adherence. Self-reported adherence was more sensitive in predicting viral load responses than MEMS-based measures and identified poor adherence at earlier time points. Approximately a quarter of consenting patients were unable to complete 30 days of MEMS monitoring, and early drop out was a poor prognostic sign. Predictors of adherence varied depending upon how adherence was measured. Differences in virologic response between patients with optimal or poor adherence may not emerge until several months after regimen change or initiation. Structured assessment of self-reported adherence is an inexpensive and useful tool to assist clinicians in monitoring adherence.

Drug Use and Medication Adherence among HIV-1 Infected Individuals

“…Regardless, our findings converge with results from several studies that have found both cocaine and methamphetamine abuse associated with decreased overall adherence Colfax & Shoptaw, 2005;Reback et al, 2003;Sharpe et al, 2004). Our findings differ from those of Matthews et al (2002) who did not find methamphetamine use to be associated with poorer HAART adherence. However, this difference can be attributed to differences in methods of assessing substance use, with their group relying on self-reported methamphetamine use data within the past 30 days, while we used both self-report and urine toxicology to assess substance use/abuse.…”

“…The use of urine toxicology reports allowed for a finer-grained analysis of actual documented substance use in close temporal proximity to when MEMS adherence data were collected. As noted above, studies that have failed to find a relationship between substance use and adherence in HIV-infected adults have relied on selfreported drug use behaviors (Crisp et al, 2004;Matthews et al, 2002;Mohammed et al, 2004) which is known to be particularly unreliable among active substance abusers (Chermack et al, 2000;Ehrman et al, 1997;Tassiopoulos et al, 2004). In addition, our study showed the differential impact of a specific class of drug (stimulants) upon adherence, and suggested that perhaps not all drugs have equally disruptive effects.…”

Self-efficacy, medication beliefs and adherence to antiretroviral therapy by patients attending a health facility in Pretoria

“…Permission was obtained from the management of Hope for Life Centre. The research instruments were tested at a separate clinic on randomly selected participants (30), who had similar characteristics to those of the sample selected for this study. This was carried out to ensure the clarity of the contents before administration of the questionnaire.…”

Assessing baseline religious practices and beliefs to predict adherence to highly active antiretroviral therapy among HIV-infected persons

“…The simplified Adult AIDS Clinical Trial Group (ACTG) adherence questionnaire, composed of five items, measures self-reported adherence to antiretrovirals (Chesney et al, 2000b;Mathews et al, 2002Mathews et al, , 2008. At each clinic visit during the follow-up period, we captured the patients' responses to these five items and then calculated summary adherence scores at three and six months after baseline.…”