A Prospective Study of Predictors of Adherence to Combination Antiretroviral Medication

Authors

  • Carol E. Golin MD,

    Corresponding author
    1. Received from the Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Sheps Center for Health Services Research (CEG), Chapel Hill, NC; the Department of Medicine, University of California–Los Angeles (HL, RDH, NSW), Los Angeles, Calif; the Divisions of Infectious Diseases and HIV Services, Harbor-UCLA Medical Center (LGM, CKB), Torrance, Calif; Yale University School of Public Health (JI), New Haven, Conn; University of North Carolina at Chapel Hill, the Departments of Medicine, and Microbiology and Immunology, and Lineberger Comprehensive Cancer Center (AHK), Chapel Hill, NC; and the UCLA Center for AIDS Research and AIDS Institute (HL, RDH, LGM, NSW), Los Angeles, Calif.
      Dr. Golin: UNC Sheps Center for Health Services Research, 725 Airport Rd., Suite 208, Chapel Hill, NC, 27599-7590 (e-mail: Carol_Golin@unc.edu).
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  • Honghu Liu PhD,

    1. Received from the Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Sheps Center for Health Services Research (CEG), Chapel Hill, NC; the Department of Medicine, University of California–Los Angeles (HL, RDH, NSW), Los Angeles, Calif; the Divisions of Infectious Diseases and HIV Services, Harbor-UCLA Medical Center (LGM, CKB), Torrance, Calif; Yale University School of Public Health (JI), New Haven, Conn; University of North Carolina at Chapel Hill, the Departments of Medicine, and Microbiology and Immunology, and Lineberger Comprehensive Cancer Center (AHK), Chapel Hill, NC; and the UCLA Center for AIDS Research and AIDS Institute (HL, RDH, LGM, NSW), Los Angeles, Calif.
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  • Ron D. Hays PhD,

    1. Received from the Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Sheps Center for Health Services Research (CEG), Chapel Hill, NC; the Department of Medicine, University of California–Los Angeles (HL, RDH, NSW), Los Angeles, Calif; the Divisions of Infectious Diseases and HIV Services, Harbor-UCLA Medical Center (LGM, CKB), Torrance, Calif; Yale University School of Public Health (JI), New Haven, Conn; University of North Carolina at Chapel Hill, the Departments of Medicine, and Microbiology and Immunology, and Lineberger Comprehensive Cancer Center (AHK), Chapel Hill, NC; and the UCLA Center for AIDS Research and AIDS Institute (HL, RDH, LGM, NSW), Los Angeles, Calif.
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  • Loren G. Miller MD, MPH,

    1. Received from the Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Sheps Center for Health Services Research (CEG), Chapel Hill, NC; the Department of Medicine, University of California–Los Angeles (HL, RDH, NSW), Los Angeles, Calif; the Divisions of Infectious Diseases and HIV Services, Harbor-UCLA Medical Center (LGM, CKB), Torrance, Calif; Yale University School of Public Health (JI), New Haven, Conn; University of North Carolina at Chapel Hill, the Departments of Medicine, and Microbiology and Immunology, and Lineberger Comprehensive Cancer Center (AHK), Chapel Hill, NC; and the UCLA Center for AIDS Research and AIDS Institute (HL, RDH, LGM, NSW), Los Angeles, Calif.
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  • C. Keith Beck MD,

    1. Received from the Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Sheps Center for Health Services Research (CEG), Chapel Hill, NC; the Department of Medicine, University of California–Los Angeles (HL, RDH, NSW), Los Angeles, Calif; the Divisions of Infectious Diseases and HIV Services, Harbor-UCLA Medical Center (LGM, CKB), Torrance, Calif; Yale University School of Public Health (JI), New Haven, Conn; University of North Carolina at Chapel Hill, the Departments of Medicine, and Microbiology and Immunology, and Lineberger Comprehensive Cancer Center (AHK), Chapel Hill, NC; and the UCLA Center for AIDS Research and AIDS Institute (HL, RDH, LGM, NSW), Los Angeles, Calif.
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  • Jeanette Ickovics PhD,

    1. Received from the Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Sheps Center for Health Services Research (CEG), Chapel Hill, NC; the Department of Medicine, University of California–Los Angeles (HL, RDH, NSW), Los Angeles, Calif; the Divisions of Infectious Diseases and HIV Services, Harbor-UCLA Medical Center (LGM, CKB), Torrance, Calif; Yale University School of Public Health (JI), New Haven, Conn; University of North Carolina at Chapel Hill, the Departments of Medicine, and Microbiology and Immunology, and Lineberger Comprehensive Cancer Center (AHK), Chapel Hill, NC; and the UCLA Center for AIDS Research and AIDS Institute (HL, RDH, LGM, NSW), Los Angeles, Calif.
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  • Andrew H. Kaplan MD,

    1. Received from the Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Sheps Center for Health Services Research (CEG), Chapel Hill, NC; the Department of Medicine, University of California–Los Angeles (HL, RDH, NSW), Los Angeles, Calif; the Divisions of Infectious Diseases and HIV Services, Harbor-UCLA Medical Center (LGM, CKB), Torrance, Calif; Yale University School of Public Health (JI), New Haven, Conn; University of North Carolina at Chapel Hill, the Departments of Medicine, and Microbiology and Immunology, and Lineberger Comprehensive Cancer Center (AHK), Chapel Hill, NC; and the UCLA Center for AIDS Research and AIDS Institute (HL, RDH, LGM, NSW), Los Angeles, Calif.
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  • Neil S. Wenger MD, MPH

    1. Received from the Department of Health Behavior and Health Education, University of North Carolina at Chapel Hill, Sheps Center for Health Services Research (CEG), Chapel Hill, NC; the Department of Medicine, University of California–Los Angeles (HL, RDH, NSW), Los Angeles, Calif; the Divisions of Infectious Diseases and HIV Services, Harbor-UCLA Medical Center (LGM, CKB), Torrance, Calif; Yale University School of Public Health (JI), New Haven, Conn; University of North Carolina at Chapel Hill, the Departments of Medicine, and Microbiology and Immunology, and Lineberger Comprehensive Cancer Center (AHK), Chapel Hill, NC; and the UCLA Center for AIDS Research and AIDS Institute (HL, RDH, LGM, NSW), Los Angeles, Calif.
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Dr. Golin: UNC Sheps Center for Health Services Research, 725 Airport Rd., Suite 208, Chapel Hill, NC, 27599-7590 (e-mail: Carol_Golin@unc.edu).

Abstract

OBJECTIVE: Adherence to complex antiretroviral therapy (ART) is critical for HIV treatment but difficult to achieve. The development of interventions to improve adherence requires detailed information regarding barriers to adherence. However, short follow-up and inadequate adherence measures have hampered such determinations. We sought to assess predictors of long-term (up to 1 year) adherence to newly initiated combination ART using an accurate, objective adherence measure.

DESIGN: A prospective cohort study of 140 HIV-infected patients at a county hospital HIV clinic during the year following initiation of a new highly active ART regimen.

MEASURES AND MAIN RESULTS: We measured adherence every 4 weeks, computing a composite score from electronic medication bottle caps, pill count and self-report. We evaluated patient demographic, biomedical, and psychosocial characteristics, features of the regimen, and relationship with one's HIV provider as predictors of adherence over 48 weeks. On average, subjects took 71% of prescribed doses with over 95% of patients achieving suboptimal (<95%) adherence. In multivariate analyses, African-American ethnicity, lower income and education, alcohol use, higher dose frequency, and fewer adherence aids (e.g., pillboxes, timers) were independently associated with worse adherence. After adjusting for demographic and clinical factors, those actively using drugs took 59% of doses versus 72% for nonusers, and those drinking alcohol took 66% of doses versus 74% for nondrinkers. Patients with more antiretroviral doses per day adhered less well. Participants using no adherence aids took 68% of doses versus 76% for those in the upper quartile of number of adherence aids used.

CONCLUSIONS: Nearly all patients' adherence levels were suboptimal, demonstrating the critical need for programs to assist patients with medication taking. Interventions that assess and treat substance abuse and incorporate adherence aids may be particularly helpful and warrant further study.

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