Risk Factors for Suboptimal Adherence Identified by Patient-Reported Outcomes Assessments in Routine HIV Care at 2 North American Clinics

Abstract

Use of patient-reported outcomes assessments (PROs) can improve patient-provider communication and focus provider attention on current health issues. This analysis examines the association between suboptimal antiretroviral therapy (ART) adherence and factors obtained through PROs among people with HIV (PWH) at 2 North American outpatient clinics. Patients and Methods: Immediately before a clinic visit, PWH completed self-administered PROs. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from logistic regression models to identify sociodemographic and health-related factors (satisfaction with ART, difficulty meeting housing costs, depression, intimate partner violence, risk of malnutrition, smoking status, alcohol use, and substance use) associated with suboptimal adherence (defined as self-reporting <95% or <80% adherence). Multiple imputation was performed to account for missing data in the multivariate analyses. Results: Of 1632 PWH, 1239 (76%) responded to the adherence assessment; of these, 268 (22%) and 106 (9%) reported <95% and <80% adherence, respectively. Of 1580 PWH who responded, 354 (22%) were dissatisfied with their HIV medication. Of responding PWH, 19% reported moderate-to-severe depression, 23% indicated they were at risk of malnutrition, 34% were current smokers, and 62% reported substance use in the past 3 months. Dissatisfaction with ART was significantly associated with <95% and <80% adherence in the unadjusted analysis (unadjusted OR [95% CI], 3.38 [2.51-4.56] and 4.26 [2.82-6.42], respectively) and adjusted analysis (adjusted OR [95% CI], 2. 76 [1.91-4.00] and 3.28 [1.95-5.52], respectively); significance remained after multiple imputation. In adjusted analyses, no risk of malnutrition was significantly associated with reduced odds of <95% adherence after multiple imputation (adjusted OR [95% CI], 0.714 [0.511-0.997]); no other factors were associated with <95% or <80% adherence. Conclusion: These results suggest that implementation of PROs evaluating treatment satisfaction may provide value to adherence management in routine HIV care.

Factors associated with incomplete adherence to integrase strand transfer inhibitor-containing single-tablet regimen among Japanese people living with HIV

“…Despite the simplicity and convenience of using INSTI-STRs, our findings indicate that some patients may not be optimally treated, highlighting the need for refinement in treatment strategies. A previous study reported that the burden regarding medication was associated with poor medication adherence [ 18 ]. Our results emphasize the importance of identifying patients’ needs and dissatisfaction with ARVs, as well as their ART adherence, in routine practice.…”

Impact of Treatment Adherence on Efficacy of Dolutegravir + Lamivudine and Dolutegravir + Tenofovir Disoproxil Fumarate/Emtricitabine: Pooled Week 144 Analysis of the GEMINI-1 and GEMINI-2 Clinical Studies

“…Most of the participants with <90% adherence withdrew for nonvirologic reasons in both the week 48 7 and week 144 analyses, suggesting that participants with lower adherence have higher attrition in the long-term trial and were either lost to follow-up or withdrew consent. Ensuring that people living with HIV are satisfied with their ART may improve adherence; 10 however, treatment satisfaction and other parameters potentially associated with adherence are not always measured in randomized clinical trials. This highlights the need for further studies to translate adherence factors from clinical trials to real-world practice.…”