Reasons for ART non-adherence in the Deep South: Adherence needs of a sample of HIV-positive patients in Mississippi

Abstract

HIV prevalence in the American Deep South has reached crisis proportions and greater numbers of patients are enrolling in clinical care and beginning antiretroviral therapy (ART). In order to gain maximum benefit from ART, patients must sustain high levels of adherence to demanding regimens over extended periods of time. Many patients are unable to maintain high rates of adherence and may need assistance to do so, which may be based upon an understanding of barriers to adherence for a given population. The current study sought to gain understanding of barriers to adherence for a mixed urban/rural HIV-positive patient population in Mississippi and to determine whether barriers to adherence may be specific to gender, employment, depressive symptoms or educational attainment status. Seventy-two patients who missed a dose of ART medication over the last three days endorsed the top five reasons for missing a dose as: (1) not having the medication with them, (2) sleeping through the dose time, (3) running out of the medication, (4) being busy with other things and (5) other. Reported barriers were fairly consistent across different groups, although women and those classified as having moderate to severe depressive symptoms reported different patterns of adherence barriers. Results suggest that adherence interventions implemented in the Deep South must take into account specific barriers faced by individuals within this region, where stigma, gender disparities and limited resources are prevalent.

Medication Adherence in HIV-Infected Smokers: The Mediating Role of Depressive Symptoms

“…As noted by Reynolds et al (2004), the reasons why people do not adhere to life-extending medication cannot be explained by any single factor. Nonadherence has been related to situational (e.g., running out of medication) and patient (e.g., depression) variables in several studies (Amico et al, 2007;Catz et al, 2000;Konkle-Parker et al, 2008). This study extends prior knowledge by documenting that cigarette smoking is associated with poor medication adherence and that the association between smoking and poor adherence is partly accounted for by differences in depression between smokers versus nonsmokers.…”

“…HIV-positive patients may not adhere for many reasons, including difficulties associated with regimen complexity, challenges in maintaining medication refills, simple forgetting, and because of the desire to avoid side effects (e.g., Amico et al, 2007;Konkle-Parker, Erlen, & Dubbert, 2008;Oggins, 2003). Adherence can be undermined by psychological factors, including stigma (Vanable, Carey, Blair, & Littlewood, 2006), fear of inadvertent disclosure (Ware, Wyatt, & Tugenberg, 2006), low self-efficacy (Godin, Côté, Naccache, Lambert & Trotter, 2005), perceived stress, and depressive symptoms (Catz et al, 2000;Herrmann et al, 2008).…”

The Information-Motivation-Behavioral Skills Model of ART Adherence in Romanian Young Adults

“…Further, the model includes a set of moderators which may dilute the potential effect of IMB model-based interventions in some contexts (including acute psychological health issues, homelessness, and active drug abuse). The model has received support from previous research with other populations on ART and has been the basis for a number of different adherence interventions (Amico et al, 2007;Amico et al, 2009;Amico, Toro-Alfonso, & Fisher, 2005;Fisher et al, 2008). It has been previously used in risk behaviour interventions in young people (Fisher et al 1996), in investigating challenges of ART adherence in HIV-positive youth (Rongkavilit et al, 2010), and ART-related views in youth at risk of HIV infection (Simon, Altice, Moll, Shange, & Friedland, 2010).…”

Educational Intervention to Improve Adherence to Anti Retro-viral Therapy (ART) among People Living with Human Immunodeficiency Virus (PLHIV) - A Randomized Controlled Trial

“…The main reasons for non-adherence were (i) didn't have the medication (ii) overslept through the dose (iii) dearth of HIV medication (iv) busy with other things (v) other reasons. This study recommended that interventions should be carried out according to individual's needs and specific problems faced by PLHIV [18].…”