Rates Of Antiretroviral Therapy Adherence Research Articles

Examination of the Role of Religious and Psychosocial Factors in HIV Medication Adherence Rates.

Optimal adherence to antiretroviral therapy (ART) is associated with favorable HIV outcomes, including higher CD4 cell counts, HIV virus suppression and a lower risk of HIV transmission. However, only 25% of people living with HIV/AIDS (PLWH) in the USA are virally suppressed. Sub-optimal adherence (<90-95%) contributes to antiretroviral resistance and worse medical outcomes, including more rapid progression to AIDS and death. Psychosocial factors and religion/spirituality (R/S) have a significant impact on ART adherence, but the findings are mixed. The purpose of this study was to examine religious and psychosocial correlates and predictors of ≥90% ART adherence in PLWH. A cross-sectional study was conducted with a sample of 292 outpatient PLWH in the Southeastern USA. Participants completed computerized surveys. The mean ART adherence percentage was 80.9% and only about half reported ≥90% adherence. There were statistically significant differences in ART adherence rates based on age, depressive symptom status and frequency of religious attendance and prayer. Praying at least once a day was significantly associated with ≥90% ART adherence (OR=2.26, 95% CI [1.06-4.79], p<0.05). Social support satisfaction was also significantly associated with ART adherence (OR=1.52, 95% CI [1.11-2.08], p<0.05) and energy/fatigue/vitality (OR=1.03, 95% CI[1.00-1.05], p<0.05).

Adherence to Antiretroviral Therapy and Associated Factors Among Adult ARV Users in Arba Minch Hospital, Southern Ethiopia

The provision of Antiretroviral Therapy (ART), HIV/AIDS is becoming a chronic manageable disease; therefore to manage chronic disease, adherence to HIV medication is very important but a variety of other factors may complicate ART adherence that needs devotion from patients, provisions of health services and health care professionals, and having social support from the society. The purpose of this study was to determine the level of adherence to ART and associated factors among adult antiretroviral drugs (ARV) users. A cross sectional study was carried out at Arba Minch Hospital from March 5 to May 5, 2015. One month patients’ self-report and pharmacy refill records were used to assess adherence. Data were collected by a standard questionnaire after pre-tested and data abstraction format. The collected data were entered in to Epi-Info and it was exported in to SPSS for data analysis. Multiple logistic regressions analysis was applied and statistical significance test was declared at P-value &lt;0.05 and OR with 95% CI. Based on patients’ self-report dose adherence, among the 428 study participants, the magnitude of adherence to ART in a month before interview was 77.10%. Multivariable analysis showed that, adherence was positively associated with sex (male) (AOR=3.03, CI (1.69-5.42)), free from substance uses (AOR=3.49, CI (1.80-6.77)), absence of side effect of drugs (AOR =2.61, CI (1.19-5.73)), ART schedule fit to daily routines (AOR= 2.93, CI (1.24-6.91)) and feeling comfort on taking ART drug in front of others (AOR=3.32, CI (1.54-7.16)). The ART adherence rate of this study was relatively low compared with WHO standard and others study in Ethiopia. Sex, feeling comfort on taking the ART drugs, ART schedule fit to daily routines, substance use and drug side effects were strong predictors of adherence.

A Cost-effectiveness Analysis of Preexposure Prophylaxis for the Prevention of HIV Among Los Angeles County Men Who Have Sex With Men.

Substantial gaps remain in understanding the trade-offs between the costs and benefits of choosing alternative human immunodeficiency virus (HIV) prevention strategies, including test-and-treat (expanded HIV testing combined with immediate treatment) and PrEP (initiation of preexposure prophylaxis by high-risk uninfected individuals) strategies. We develop a mathematical epidemiological model to simulate HIV incidence among men residing in Los Angeles County, California, aged 15-65 years, who have sex with men. We combine these incidence data with an economic model to estimate the discounted cost, effectiveness (quality-adjusted life-years [QALYs]), and incremental cost-effectiveness ratios of various HIV prevention strategies using a societal perspective and a lifetime horizon. PrEP and test-and-treat yield the largest reductions in HIV incidence, and are highly cost-effective ($27 863/QALY and $19 302/QALY, respectively) relative to status quo and at a US willingness-to-pay threshold of $150 000/QALY saved. Status quo and 12 test-and-treat and PrEP strategies determine the frontier for efficient decisions. More aggressive strategies are costlier, but more effective, albeit with diminishing returns. The relative effectiveness of PrEP is sensitive to the initial HIV prevalence rate, PrEP and antiretroviral therapy (ART) adherence and initiation rates, the probabilities of HIV transmission, and the rates of sexual partner mixing. PrEP and test-and-treat offer cost-effective alternatives to the status quo. The success of these strategies depends on ART and PrEP adherence and initiation rates. The lack of evidence on adherence behaviors toward PrEP, therefore, warrants further studies.

Antiretroviral therapy initiation and adherence in rural South Africa: community health workers’ perspectives on barriers and facilitators

ABSTRACTSouth Africa has the largest global HIV/AIDS epidemic, but barriers along the HIV care continuum prevent patients from initiating and adhering to antiretroviral therapy (ART). To qualitatively explore reasons for poor ART initiation and adherence rates from the unique perspective of community health workers (CHWs), we conducted focus groups during May–August 2014 with 21 CHWs in rural Msinga, KwaZulu-Natal. Interviews were audio-recorded, transcribed, and translated from Zulu into English. Hybrid deductive and inductive analytical methods were applied to identify emergent themes. Multiple psychosocial, socioeconomic, and socio-medical barriers acted at the level of the individual, social network, broader community, and healthcare environment to simultaneously hinder initiation of and adherence to ART. Key themes included insufficient patient education and social support, patient dissatisfaction with healthcare services, socioeconomic factors, and tension between ART and alternative medicine. Fear of lifelong therapy thwarted initiation whereas substance abuse principally impeded adherence. In conclusion, HIV/AIDS management requires patient counselling and support extending beyond initial diagnosis. Treating HIV/AIDS as a chronic rather than acute infectious disease is key to improving ART initiation and long-term adherence. Public health strategies include expanding CHWs' roles to strengthen healthcare services, provide longitudinal patient support, and foster collaboration with alternative medicine providers.

The Information and Motivation and Behavioral Skills Model of ART Adherence among HIV-Positive Adults in Mexico.

Middle-income countries are in need of research that uses theoretical-based models to assess factors that predict adherence to antiretroviral therapy (ART) and help in the design, implementation, and evaluation of interventions for nonadherent populations. In Mexico, the Information and Motivation and Behavioral Skills (IMB) Model of ART Adherence constructs is useful in describing and predicting adherence behaviors in various samples but has not been articulated to people living with HIV (PLWH) on ART. The aim of this was to characterize the IMB core constructs and identify correlates of ART adherence in an HIV-positive clinic sample in Mexico. A convenience sample of 109 HIV-positive patients attending their monthly visits at a local public hospital were interviewed with the Spanish version of the LifeWindows IMB ART Adherence Questionnaire (LW-IMB-AAQ) as well as a sociodemographic questionnaire. All participants were recruited from a hospital-based outpatient clinical care site. Partial confirmation of the relationships proposed by the IMB Model of ART Adherence was found. As predicted by the model, only behavioral skills had direct association with all measures of self-reported adherence, and motivation was associated with behavioral skills. Information did not demonstrate significant relations to either motivation or behavioral skills, nor did it directly associate with adherence. Self-reported adherence did not associate with CD4 counts, nor did any of the IMB model core constructs. Applicability of the IMB Model of ART Adherence in this setting is discussed. The IMB Model of ART Adherence offered promise in this population and could help tailor population-specific interventions to promote high rates of ART adherence.

HIV Prevention, Treatment, and Care for People Who Inject Drugs

HIV Prevention, Treatment, and Care for People Who Inject Drugs

Adherence to antiretroviral therapy in India: A systematic review and meta-analysis

Objective:To assess the adherence to antiretroviral therapy (ART) in the human immunodeficiency virus (HIV)-infected population in India.Design:Systematic review and meta-analysis.Materials and Methods:The Medline and Cochrane library database were searched. Any prospective or retrospective study enrolling a minimum of 10 subjects with a primary objective of assessing ART adherence in the HIV population in India was included. Data were extracted on adherence definition, adherence estimates, study design, study population characteristics, recall period and assessment method. For metaanalysis, the pooled proportion was calculated as a back-transform of the weighted mean of the transformed proportions (calculated according to the Freeman-Tukey variant of the arcsine square root) using the random effects model.Results:There were seven cross-sectional studies and one retrospective study enrolling 1666 participants. Publication bias was significant (P = 0.003). Pooled results showed an ART adherence rate of 70% (95% confidence interval: 59–81%, I2 = 96.3%). Sensitivity analyses based on study design, adherence assessment method and study region did not influence adherence estimates. Fifty percent (4/8) of the studies reported cost of medication as the most common obstacle for ART adherence. Twenty-five percent (2/8) reported lack of access to medication as the reason for non-adherence and 12% (1/8) cited adverse events as the most prevalent reason for non-adherence. The overall methodological quality of the included studies was poor.Conclusion:Pooled results show that overall ART adherence in India is below the required levels to have an optimal treatment effect. The quality of studies is poor and cannot be used to guide policies to improve ART adherence.

Treating depression in HIV-positive patients affects adherence

Aim. To determine changes in adherence to antiretroviral therapy (ART) in HIV-positive patients with depression, following treatment with an antidepressant or psychotherapy. &#x0D; &#x0D; Methods. The study was prospective, randomised and controlled. Consenting volunteers aged ≥18 years and stable on ART for ≥6 months were included in the study. Sociodemographic data were obtained, and a clinical diagnostic evaluation and the Hamilton Depression rating scale (HAMD) were performed on all subjects at entry to and at the end of the study. Participants found to be depressed were randomly assigned antidepressant treatment (20 mg citalopram) or interpersonal psychotherapy (IPT) (5 sessions). Medication was dispensed at each visit and patients were asked to return all unused medication to determine ART adherence. The study was approved by the University of the Witwatersrand. &#x0D; &#x0D; Results. Sixty-two HIV-positive persons receiving ART participated; 30 were not depressed (control group) and 32 were depressed (patient group). No significant differences in demographic characteristics existed between the control and patient groups. Mean ART adherence at the start of the study was 99.5% (standard error (SE) ±0.46) and 92.1% (SE ±1.69) in the control and patients groups, respectively. Mean ART adherence at the end of the study changed marginally in the control group (99.7%; SE ±0.46) and increased significantly in the patient group (99.5%; SE± 0.13) (p&gt;0.05). The mean ART adherence rate of patients who received pharmacotherapy increased from 92.8% to 99.5%, and of those who received psychotherapy increased from 91.1% to 99.6% (p&gt;0.05). There was no significant association between the increased adherence in the patient group and baseline demographic and clinical characteristics, irrespective of antidepressant therapy or IPT (p&gt;0.05). &#x0D; &#x0D; Conclusion. Successful treatment of depression with an antidepressant or psychotherapy was associated with improved ART adherence, independent of the type of treatment and sociodemographic factors. It is necessary to identify HIV-positive patients at risk of depression, to initiate antidepressant treatment which may prevent ART non-adherence, and subsequent disease progression and increased morbidity.

Partner Reports of Patients' HIV Treatment Adherence

Decades of clinical research have documented the positive impact of supportive social interactions on health promotion and health outcomes.1, 2 This is particularly relevant in the context of HIV prevention and care, in which the social environment is characterized by stigma, shame, and homophobia, and where persons living with HIV have higher likelihood of substance abuse, depression, and anxiety. These forces threaten successful management of HIV disease, which often depends on timely initiation of and careful adherence to antiretroviral therapy (ART). Given the social context of HIV disease management, the role of spouses and partners in supporting HIV treatment adherence is gaining interest in clinical research and practice. High rates of ART adherence are critical to optimize clinical outcomes, but how to measure adherence is a resilient debate in HIV research and practice.3 The most common approach employs self-reports of adherence, and several such measures have demonstrated evidence of reliability and validity when compared to criteria such as electronic medication monitoring and HIV viral load. However, there is no doubt that selfreported adherence data are eroded by bias, including social desirability and memory effects that contribute to inflated estimates of adherence. The current analyses were conducted to determine whether partners’ reports of patients’ adherence are a better gauge of medication adherence than self-report by the patient.

Methadone maintenance therapy promotes initiation of antiretroviral therapy among injection drug users.

Despite proven benefits of antiretroviral therapy (ART), many human immunodeficiency virus (HIV)-infected injection drug users (IDU) do not access treatment even in settings with free health care. We examined whether methadone maintenance therapy (MMT) increased initiation and adherence to ART among an IDU population with free health care. We examined prospectively a cohort of opioid-using antiretroviral-naive HIV-infected IDU and investigated factors associated with initiation of antiretroviral therapy as well as subsequent adherence. Factors associated independently with time to first initiation of antiretroviral therapy were modelled using Cox proportional hazards regression. Between May 1996 and April 2008, 231 antiretroviral-naive HIV-infected opioid-using IDU were enrolled, among whom 152 (65.8%) initiated ART, for an incidence density of 30.5 [95% confidence interval (CI): 25.9-35.6] per 100 person-years. After adjustment for time-updated clinical characteristics and other potential confounders, use of MMT was associated independently with more rapid uptake of antiretroviral therapy [relative hazard = 1.62 (95% CI: 1.15-2.28); P = 0.006]. Those prescribed methadone also had higher rates of ART adherence after first antiretroviral initiation [odds ratio = 1.49 (95% CI: 1.07-2.08); P = 0.019]. These results demonstrate that MMT contributes to more rapid initiation and subsequent adherence to ART among opioid-using HIV-infected IDU. Addressing international barriers to the use and availability of methadone may increase dramatically uptake of HIV treatment among this population.

Antiretroviral Therapy Adherence Among Transgender Women Living With HIV

Despite disproportionate rates of HIV among transgender women and evidence that medication adherence is necessary for treatment success and increased likelihood of survival, there has been little investigation into antiretroviral therapy (ART) adherence issues among transgender women. This study examined rates of self-reported ART adherence among transgender women on ART (n = 35) and well-established correlates of nonadherence, including depression, adherence self-efficacy, patient perceptions of interactions with their providers, and perceived adverse side effects of ART compared to other respondents (n = 2,770). Transgender women on ART were less likely to report 90% adherence rates or higher and reported less confidence in their abilities to integrate treatment regimens into their daily lives. When transgender women were compared to other respondents, regardless of the current medication regimen, they reported significantly fewer positive interactions with their health care providers. Training for providers and integration of hormone therapy into HIV care is recommended.

Trauma, anxiety and reported health among HIV-positive persons in Tanzania and the US Deep South

Little research has been conducted in less wealthy nations to evaluate the prevalence of severe life traumas in general population groups and the impact of such traumas. Previous studies in wealthy nations have found that experiencing severe traumas can cause elevated levels of anxiety, but few studies have examined this association in non-disaster situations in less wealthy nations. Trauma and trauma-related anxiety are associated with greater sexual risk taking behaviours, lower HIV medication adherence levels and poorer health outcomes in wealthy nations. The objectives of this manuscript are: (1) to compare rates of trauma in two HIV-positive samples from areas that have not experienced disaster situations that are recognized by the international community as traumatic events; and (2) to examine whether the reported traumatic experiences are similarly associated with self-reported mental and physical health. The samples come from a region of a wealthy nation that consistently experiences large increases in incident AIDS cases and where the epidemic is largely transmitted heterosexually (Deep South, United States; n =611) and a region in a less wealthy nation with relatively high HIV prevalence and incidence rates and where transmission is also primarily heterosexual (Moshi, Tanzania; n =72). Compared to the US sample, the Tanzanian sample reported significantly higher rates of trauma in the areas of illness, injury, accidents and “other” significant traumas, a higher prevalence of anxiety and poorer physical health. The experience of trauma was similarly associated with greater mental health symptomatology and poorer physical health in both samples. Further investigation into the area of trauma and its sequelae is warranted, particularly in relation to risk behaviours and HIV medication adherence. At a time of increasing anti-retroviral therapy (ART) availability in less wealthy nations, additional focus on trauma care could improve ART adherence rates and reduce risk behaviors, thereby assisting in stemming the further spread of the epidemic.

Marijuana Use and Its Association With Adherence to Antiretroviral Therapy Among HIV-Infected Persons With Moderate to Severe Nausea

Adherence to antiretroviral therapy (ART) is essential to successful treatment of HIV infection. Two recent studies reported a negative correlation between marijuana use and adherence to ART. Some patients, however, report that smoking marijuana improves adherence to ART. This study therefore sought to identify which subgroups of patients may have differential adherence to ART in association with recent marijuana use. Cross-sectional survey design within a public health care system for HIV/AIDS. With a 5% refusal rate, 252 patients completed the interview, 175 (69%) were on ART, and 168 (67%) provided ART adherence data. Forty-one subjects (24%), predominantly whites, used marijuana. In bivariate analysis, no association between ART adherence and marijuana use was found (odds ratio [OR] = 0.92, 95% CI = 0.4-1.9). Adherence was positively associated with undetectable plasma virus and negatively associated with alcohol and other illicit drug use. Examining subgroups of patients, among those with nausea, marijuana users were more likely to show an association with adherence than nonusers (OR = 3.3), while among those without nausea, marijuana use was lower associated with adherence (OR = 0.52, P for homogeneity 0.02). This relationship was confirmed in multivariate analyses controlling for the interactions between nausea and marijuana use, in which other illicit drug use remained a factor related to nonadherence. These data suggest that medicinal use of marijuana may facilitate, rather than impede, ART adherence for patients with nausea, in contrast to the use of other illicit substances, which were associated with lower rates of ART adherence. To demonstrate any causal relationship between marijuana and adherence would require a longitudinal or controlled study.