Highly Active Antiretroviral Therapy Adherence Research Articles

To explore patients’ perceptions about motivators and barriers of adherence to highly active antiretroviral therapy among people living with HIV: A qualitative study

ABSTRACT Objective: For people living with HIV (PLHIV), strict adherence to highly active antiretroviral therapy (HAART) is the key to effective treatment and retention in human immunodeficiency virus (HIV) care. There are many factors which promote or halt the antiretroviral therapy (ART) adherence practices. Therefore, the present study aimed to examine the HAART adherence levels and to explore patients’ views about barriers and facilitators to HIV treatment adherence. Methods: Semi-structured interviews were conducted among 15 PLHIV at the ART clinic of Dr. Ram Manohar Lohia Hospital, New Delhi. Interviews were audio-recorded in the local Hindi language, and bilingual experts (English and Hindi) transcribed verbatim. Qualitative data were coded for themes and subthemes and analyzed using a phenomenological approach as per thematic content analysis. Results: Feeling of hopelessness, delayed ART initiation, difficult initial phase of ART, forget to take ART on time, fear of disclosure of HIV diagnosis, lack of privacy and negative social support, and impact of lockdown due to COVID-19 were revealed as significant barriers to ART adherence. At the same time, commitment to raise and educate children, ART to increase life span, maintain oneself to be physically fit and healthy, only a single pill per day, very supportive counselors and health-care professionals, and hope to give birth to a healthy child were identified as facilitators of HIV retention. Conclusion: Understanding patient’s perception about ART adherence, its motivational and barrier factors which are directly affecting ART adherence and retention of PLHIV in HIV treatment and follow-ups are of utmost importance to improve ART adherence during HIV patient care services.

Preventing Medication Nonadherence of Youth (13–24 Years) With HIV Initiating Antiretroviral Therapy

PurposeThe objective of this study was to evaluate the feasibility and acceptability of a dynamic, behavioral intervention to optimize medication adherence of adolescents and young adults (AYAs) with HIV newly initiating highly active antiretroviral therapy (HAART) and explore its efficacy on adherence and disease outcomes. MethodsThe two-arm randomized controlled trial piloted a brief, individualized intervention designed for direct integration into standard clinical care. In total, 32 AYAs with a confirmed HIV diagnosis, reportedly horizontally acquired, and recommended to initiate HAART completed a two-week placebo trial before HAART initiation and were subsequently randomized to standard of care or the individualized intervention. Adherence and disease outcomes were measured over the first six months of HAART. ResultsResults supported the primary study aim regarding feasibility (recruitment = 89%, attendance = 81%–100%, intervention exercise completion = 100%) and acceptability (average favorable response = 89%). Data also supported the positive effect of the intervention on select HAART adherence measures and disease outcomes. Adherence (by pharmacy refill) declined in both groups; however, adherence declined more slowly in the intervention group versus standard of care (p < .001). In addition, 100% of participants receiving the intervention obtained an undetectable viral load by 3 months and maintained an undetectable viral load at 6 months (vs. 68.8% standard of care). ConclusionsThis is one of the first interventions to target adherence for AYAs with HIV newly initiating HAART and designed for delivery in existing clinical care settings. Future research will help confirm efficacy and the potential utility of the intervention in promoting HAART adherence from medication initiation and preventing the decrease in adherence often observed over time.

Adherence to highly active antiretroviral therapy among people living with HIV and associated high-risk behaviours and clinical characteristics: A cross-sectional survey in Vietnam.

Although Vietnam has promoted the utilisation of highly active antiretroviral therapy (HAART) towards HIV elimination targets, adherence to treatment has remained under-investigated. We aimed to describe high-risk behaviours and clinical characteristics by adherence status and to identify the factors associated with non-adherence. We included 426 people living with HIV (PLWH) currently or previously involved in HAART. Most participants were men (75.4%), young (33.6years), with low income and low education levels. Non-adherent PLWH (11.5%) were more likely to have a larger number of sex partners (p-value = 0.053), sex without condom use (p-value = 0.007) and not receive result at hospital or voluntary test centre (p-value = 0.001). Multiple logistic regression analysis showed that demographic (education levels), sexual risk behaviours (multiple sex partners and sex without using condom) and clinical characteristics (time and facility at first time received HIV-positive result) were associated with HAART non-adherence. There are differences in associated factors between women (education levels and place of HIV testing) and men (multiple sex partners). Gender-specific programs, changing risky behaviours and reducing harms among PLWH may benefit adherence. We highlight the need to improve the quantity and quality of HIV/AIDS services in Vietnam, especially in pre- and post-test counselling, to achieve better HAART adherence, working towards ending AIDS in 2030.

Impact of Insurance Status on Outcomes in Patients with AIDS-Defining Cancers

Background: Mortality among people living with the human immunodeficiency virus (PLWH [HIV]) diagnosed with acquired immunodeficiency syndrome (AIDS)-defining cancers has greatly decreased with the advent of highly active antiretroviral therapy (HAART). Recent investigations exploring the impact of insurance coverage have concluded that PLWH with public insurance have greater mortality than their privately insured counterparts. One avenue to augment medical coverage is the Ryan White HIV/AIDS Program, first authorized by Congress in 1990 to provide primary care and support services to PLWH. This study sets out to elucidate whether insurance coverage and Ryan White assistance affect treatment parameters and survival rates in PLWH diagnosed with Kaposi sarcoma (KS) and non-Hodgkin lymphomas (NHL). Methods: This was a retrospective cohort study of PLWH diagnosed with KS or NHL between 2004 and 2018. Baseline characteristics including demographics, insurance coverage, Ryan White assistance, CD4+ T-cell counts, HIV viral load, HAART treatment, performance status, and disease stage were collected. Participants were classified as having private insurance, Medicare, Medicaid, or no insurance. Treatment regimens were assessed as "optimal" or "suboptimal" using the National Comprehensive Cancer Network guidelines for AIDS-related KS and lymphomas as benchmark. Hazard ratios (HR) for survival were calculated using Cox proportional hazards regression models. Results: Among 191 participants with AIDS-defining cancers, 107 had KS, and 96 had aggressive NHL. 18% had private insurance, 14% had Medicare, 46% had Medicaid, and 23% had no health insurance; 44% received Ryan White assistance. Participants with Medicare and those without Ryan White assistance were older. Those with Ryan White assistance also had better performance status (defined as having an Eastern Cooperative Oncology Group score of 0 to 2). There were no significant differences in CD4+ T-cell counts, HIV viral loads, HAART adherence, treatment delays, regimen selection, and response rates across the insurance and Ryan White groups. The median treatment delay for all participants was 20 days. In general, participants with Medicare had lower overall survival than privately insured participants (HR 2.99, 95% confidence interval [CI] 1.14-7.87, p = 0.027). Participants without Ryan White assistance also had lower overall survival (HR 2.82, 95% CI 1.49-5.35, p = 0.002) and progression-free survival (HR 2.56, 95% CI 1.47-4.44, p &amp;lt; 0.001) than those with assistance. Other factors that influenced overall survival were age (adjusted HR 1.04 per year of age; 95% CI 1.01-1.06; p = 0.007), Hispanic ethnicity (adjusted HR 0.46 compared to Whites; 95% CI 0.24-0.91; p = 0.025), and poor performance status (adjusted HR 6.14; 95% CI 3.39-11.12; p &amp;lt; 0.00001). Conclusions: Our study is among the first to examine the impact of insurance coverage on outcomes in AIDS-defining malignancies. We find that PLWH with Medicare and those not receiving Ryan White assistance have lower survival. These differences may be ascribed in part to discrepancies in age, performance status, and prevalence of AIDS- and non-AIDS-related comorbidities. Reassuringly, our analysis suggests Ryan White assistance, despite its coverage limitations, is not associated with increases in treatment delays or suboptimal regimens. Nevertheless, the importance of dedicated care for this population at a multidisciplinary HIV/AIDS and comprehensive cancer center should not be undervalued. Future research should focus on whether the observed differences can be more broadly replicated in the United States. Figure Disclosures No relevant conflicts of interest to declare.

Health related quality of life of people receiving highly active antiretroviral therapy in Southwest Ethiopia.

Highly Active Antiretroviral Therapy (HAART) is a standard of HIV management to suppress viral load and delay progression to AIDS. However, questions have been raised about the use of antiretroviral therapy and how it affects quality of life (QoL) of people living with HIV/AIDS (PLWHA). The study hence aimed to assess the QoL of PLWHA who were taking HAART at Mizan-Tepi University Teaching Hospital (MTUTH) and identify factors associated with QoL. A cross sectional study was conducted among PLWHA receiving HAART at MTUTH from March 04-April 1, 2018. Patients were recruited consecutively and interviewed with structured questionnaire. A data abstraction tool was used to extract data from patient medical records. Quality of life was assessed using the World Health Organization Quality of Life HIV- BREF (WHOQOL-HIV-BREF) standard tool. Data was entered to Epi-Info version 3.5.3 and analyzed using SPSS version 22 for windows. A multivariable logistic regression analysis was fitted to identify factors associated with QoL. A statistical significance was established at a p value <0.05. A total of 240 participants with the mean age of 35.11 (SD = 9.08) years were included in the study. This study found that 57.1% of the patients had high global score of QoL. Patients with normal current health (AOR = 3.38, 95% CI = 1.56-7.31)) and having family support (AOR = 3.12, 95% CI = 1.51-6.46) were positively associated with high global score of QoL, while patients with low HAART adherence (AOR = 0.40, 95%, CI = 0.19-0.86) were negatively associated with high global score of QoL. The study revealed that more than half of the participants had high global score of QoL. Normal current health and family support were associated with better global score of QoL, while low HAART adherence was found to be associated with the lower global score of QoL.

Meta-analysis of adherence to highly active antiretroviral therapy in patients with HIV infection in China

ABSTRACTWith the widespread implementation of antiretroviral therapy in many countries, the HIV/AIDS epidemic has declined. However, little is known about the prevalence of adherence rate to Highly Active Antiretroviral Therapy (HAART) in patients with HIV infection in China. This is the first meta-analysis of cross-sectional studies of treatment adherence (≥ 95%) to HAART in Chinese patients. Both English (PubMed, PsycINFO, EMBASE, and Web of Science) and Chinese (WanFang, CNKI, and SinoMed) databases were systematically and independently searched by three investigators. Studies with adherence rate estimates of HAART were included. Adherence rate estimates of each eligible study were extracted and pooled using the random-effects model. A total of 40 studies conducted in China were eligible and analyzed. The mean rate of ≥ 95% adherence to HAART was 81.1% (95%CI: 75.1%–88.0%, I2 = 97.3%) at one week, 80.9% (95%CI: 74.7%–85.9%, I2 = 96.6%) at one month, and 68.3% (95%CI: 46.1%–84.4%, I2 = 97.1%) at 3 months or longer. Subgroup analyses revealed that samples with no gender predominance, low education level, middle economic region, rural area, older age (42.3 years), and recent publication (2013 or later) were correlated to higher HAART adherence. The average rate of HAART adherence was relatively high in China, which indicates effective HIV/AIDS policy, prevention and control measures. However, the HAART adherence rate decreased over the study time period.

Evaluating the relationship between adherence to Highly Active Antiretroviral Therapy (HAART) and social and clinical characteristics in Chinese patients with HIV

ABSTRACTThis study investigated the adherence rate of Highly Active Antiretroviral Therapy (HAART) in patients with HIV infection in China. The research also examined the adherence rate related to demographic and clinical characteristics with these patients. A total of 516 patients with HIV infection were enrolled from the Wuhan Provincial Center for Disease Control and Prevention. Patients reported their one-month HAART adherence rate, as well as their demographic and clinical characteristics. Using the ≥95% HAART one-month adherence rate, the patients were divided into an adherence group and a non-adherence group. The two groups were compared to identify differences. Compared to the adherence group (92.2%), the non-adherence patients (7.8%) experienced greater perceived stigma as measured by Berger Stigma Scale, and tended to have more homosexual sexual partners. Logistic regression analyses revealed that having less confidence in HAART treatment (p = 0.04, OR = 0.2, 95% CI = 0.03–0.9) and more homosexual sex partners (p = 0.049, OR = 1.5, 95% CI = 1.0–2.3) were independently associated with HAART non-adherence. More attention should be paid to patients with HIV infection who did not adherence to HAART treatment. Regular screening and psychological and social support should be considered as an intervention with non-adherence patients living with HIV.

PIN102 - IMPACT OF DEPRESSION AND ITS ASSOCIATION TO HIGHLY ACTIVE ANTIRETROVIRAL THERAPY ADHERENCE AND ADVERSE DRUG REACTIONS IN PEOPLE LIVING WITH HIV IN INDIA

In resources limited countries because of social stigma issues, depression and intentional non adherence do exist. Optimal adherence to HAART (>95%) in People Living with HIV (PLW-HIV) is difficult. Therefore there is a need to evaluate the severity of depression, its association to HAART adherence and Adverse Drug Reactions( ADRs) related to HAART in PLW-HIV in India. A prospective observational study was carried out in south Indian teaching Hospital in Manipal. Patients were enrolled and informed consent was obtained. As per the inclusion criteria administered with two questionnaires; PHQ 9 Questionnaire and ACTG Adherence Questionnaire. Enrolled Patients were assessed for assessment of severity of depression using PHQ 9 Questionnaire and using ACTG adherence questionnaire. Results were analyzed using Chi-Square test find out the association between adherence and its impact on depression. Reported ADRs were also analyzed based on WHO's and Naranjo’s causality assessment, severity, predictability and preventability Scales. Total 150 patients were enrolled in the study, out of which 33 patients had mild depression 27(81.8%) followed by moderate 3(9%), followed by moderately severe 3(9%) depression with HAART and 146(97.3%) patients were reported to have adherence rate more than 95% for HAART. Number of depression cases with HAART was higher in males 27(81.8%) compared to females 6(18.2%). A significant association between PHQ 9 outcomes 117(100%) (p value <0.005) and patients on HAART without depression was found. 52(34.7%) of the patients was prescribed with Tenofovir+Efavirenz+Lamivudine. 39(26%) patients reported ADRs to HAART, Out of which 5(12.8%) patients reported Efavirenz induced depression, Other ADRs were Zidovudine induced anemia 7(17.9%), Tenofovir induced acute kidney infection 5(12.8%) and Lamivudine induced Skin Rashes 3(7.6%). The impact of depression and its association to HAART needs to be emphasized. Awareness on medication adherence to HAART is essential in People living with HIV In India.

Explaining Adherence to HAART among Patients Living with HIV/AIDS in Nigeria: Behavioral Theory Analysis

Background: The number of Nigerians infected with the HIV infection in 2016 was about 3 million, which was the second highest burden globally and accounted for 9% of the worldwide burden of the HIV/AIDS. The country ART (antiretroviral therapy) programme which commenced in 2001 had adult coverage of 48.3% in 2014. Effectiveness of the antiretroviral drug regimens requires a very good level of adherence (95%) to suppress viral replication. Despite all the strategies to address the adherence barriers to HAART (highly active antiretroviral therapy), the problems of poor adherence are ever-present. Factors determining adherence to HAART drug regimens have been studied in various population but little is known on this subject among PLHIV (people living with HIV) in Nigeria. Identifying and overcoming the factors that reduce adherence to combination antiretroviral agents is of utmost importance for prolonged viral load suppression. Very few of the strategies developed to mitigate the challenges of non-adherence were based on the theories of health behavior. However, behavioural theories, if adopted, could assist in the development of more effective interventions to improve treatment adherence. This cross-sectional study was conducted to explain the dynamics of HAART adherence among Nigerians living with HIV/AIDS; using behaviour change theories such as the Theory of Planned Behavior (TPB) and Health Belief Model (HBM). Methods: This was a questionnaire-based study using closed ended-questionnaires administered by the on the 225 participants. Findings: There were more female (181, 80.40%) than male (19.6%) living with HIV infection among the respondents. More than half, (139, 61.7%), of the respondents were married while less than a fifth (66; 29%) were singles About 96% of the respondents were literate with 2.7% illiteracy rate. Employment rate was also more than half (59%) while the unemployed rate was about 31.6%. Most (202, 89.8%) were of the Christianity faith TPB model factors such as the ability to set realistic goals and objectives with respect to medication adherence and meet such goals did not have any significant association with adherence (P 0.001) among the PLHIV. Likewise other TPB factors like determination and self-discipline to adhere to medications (HAART) did not have statistical association with HAART adherence. On the other hand, Health Believe Model (HBM) components such as the believes that adherence to HAART improves HIV patent's health condition (P=0.004),adherence to HIV medication is feasible in the Nigerian context (P=0.00), refusal to adhere to HAART is a serious health risk for the HIV patient (P=0.00), non-adherence to HAART is life threatening for the HIV patient(P=0.00), non-adherence to HAART can lead to AIDS faster (P=0.00) and the consequences of non-adherence to HAART are severe (P=0.00) all show significant statistical association with HAART adherence .Also significant statistical association was found between HAART adherence and other health believes like adherence to HAART is beneficial (P=0.00). Conclusion: Unlike the theory of planned behaviour, health believes Model was most suited to explaining or predicting patterns of HAART adherence behaviour among Nigerians PLHIV. However, for the model to be most effective it would need to be integrated with other models that take into account the environmental context and recommend strategies for change.

Cervical cancer screening practices, knowledge of screening and risk, and highly active antiretroviral therapy adherence among women living with human immunodeficiency virus in Lima, Peru.

Cervical cancer (CC) is the leading cause of cancer death among Peruvian women. Awareness shown by women living with HIV (WLHIV) of their increased risk and Papanicoloau (Pap) smear frequency is understudied, particularly in Peru. We assessed the uptake of guidelines-based CC screening practices and its associations with two predictors, knowledge of CC screening and risk and highly active antiretroviral therapy (HAART) adherence, among WLHIV. Collected by self-administered questionnaires from 2014 to 2016, we analyzed the data of 71 WLHIV. Most WLHIV (77.5%, n = 55/71) were overdue to CC screening by not having a Pap smear within the prior 12 months. WLHIV who had on-time Pap smears had a higher median composite 'knowledge' score of 3.0 ([interquartile range] 1.5-4) compared to 2.0 (IQR 1-3) for overdue WLHIV. On-time and overdue WLHIV had the same median composite 'HAART adherence' score of 3.0 (IQR 2-4). Bivariate analysis found no association between knowledge nor adherence with on-time Pap smears. Although on-time WLHIV were more knowledgeable about CC screening and risk, overall CC screening uptake was poor. Larger studies of this population are needed to assess the educational, social, and structural barriers contributing to this low prevalence of screening.

HIV Positive Status Disclosure and Highly Active Antiretroviral Therapy Adherence among People Living with HIV in Ambo Hospital, West Shewa Zone, Oromia Region, Ethiopia

Background: HIV sero status disclosure and adherence to Highly Active Antiretroviral Therapy (HAART) medication are important for the prevention and control of HIV/AIDS. Little is known about the relationship between HIV positive status disclosure and highly active anti-retroviral therapy (HAART) adherence in developing countries including Ethiopia. The aim of this study was to explore the relationship between HIV status disclosure and HAART adherence. Method: A cross-sectional study using quantitative research approach supplemented by qualitative methods was conducted from January to February 2012 on 420 people living with HIV (PLHIV) attending ART clinic in Ambo Hospital. Simple random sampling method was used to select the study participants. Data were collected through face to face interview and focus group discussion using pre-tested structured questionnaire and semi structured interview guides, respectively. Crude and adjusted odds ratios using logistic regression analysis were used to explore associations between different variables and HIV status disclosure and ART adherence. Results: The study revealed that the prevalence of HIV status disclosure to at least one person and highly active anti-retroviral therapy adherence were 86.2% (95% CI: 82.52-89.34) and 86% (95% CI: 82.2-89.13) respectively. Prevalence of HAART adherence among PLHIV who disclosed their sero status was 88.7% (95% CI: 84.95-91.75) where as the prevalence of HAART adherence among PLHIV who did not disclose their status was 69% (95% CI: 55.46-80.46). HIV status disclosure to at least one person (AOR=3.42, 95%CI: 1.60-7.29) and being literate (AOR=2.13, 95%CI: 1.08-4.22) were significantly associated with HAART adherence. Conclusion: HIV positive status disclosure was a significant predictor of HAART adherence. Hence, intervention programs to improve HAART adherence should consider the potential benefits of HIV status disclosure.

Analysis on antiretroviral therapy efficacy for HIV/AIDS in Zhejiang province, 2009-2014

To analyze the efficacy of highly active antiretroviral therapy(HAART)for HIV/AIDS in Zhejiang province from 2009 to 2014. A retrospective cohort study was conducted among patients with access to HAART aged <15 years from 2009 to 2014 through descriptive epidemiological analysis on the patients' demographic characteristics, HAART efficacy. The immune recovery Kaplan-Meier curves were drawn by using baseline CD(4) T lymphocytes cell(CD(4))data. The influencing factors for virus suppression were analyzed by using logistic regression model. There were 9 594 patients with access to HAART in Zhejiang from 2009 to 2014. The' average age of the patients was 38.7 years old, the male to female ratio was 4.11∶1. Heterosexual(55.9%)and homosexual(40.0%)contacts were the main transmission routes. Baseline CD(4) count 200-349 cells/μl was found in 45.4% of the patients, the median of the CD(4) count was 221(IQR: 123-298). The median of time for CD(4) recovery in patients with baseline CD(4) count <200 cells/μl was 3.48 and 11.58 times higher than the patients with baseline CD(4) count 200-349 cells/μl and baseline CD(4) count ≥350 cells/μl. Univariate and multivariate logistic regression analyses showed that marital status, HAART regimen, treatment miss in last week and CD(4) recovery were major influencing factors for HAART efficacy. HAART had good treatment effecacy in HIV/AIDS patients in Zhejiang. The baseline CD(4) count and adherence to HAART were the most important influencing factors. It is recommended to take measures to expand HIV screening and HAART coverage, conduct HAART adherence education, and strengthen the special care for high-risk groups to improve the HAART efficacy in Zhejiang province.

Risk factors for Kaposi's sarcoma in human immunodeficiency virus patients after initiation of antiretroviral therapy: A nested case-control study in Kenya.

This study aimed to evaluate the association between highly active antiretroviral therapy (HAART) adherence and development of Kaposi's sarcoma (KS) in human immunodeficiency virus (HIV)/AIDS patients. We conducted a retrospective nested case-control study of 165 participants (33 cases and 132 controls) receiving HAART care at Maseno Hospital, Kenya, from January 2005 to October 2013. Cases were HIV-positive adults with KS, who were matched with controls in a ratio of 1:4 based on age (±5years of each case), sex, and KS diagnosis date. Perfect adherence to HAART was assessed on every clinic visit by patients' self-reporting and pill counts. Chi-square tests were performed to compare socioeconomic and clinical statuses between cases and controls. A conditional logistic regression was used to assess the effects of perfect adherence to HAART, the latest CD4 count, education level, distance to health-care facility, initial World Health Organization stage, and number of regular sexual partners on the development of KS. Only 63.6% participants reported perfect adherence, and the control group had a significantly higher percentage of perfect adherence (75.0%) than did cases (18.2%). After adjustment for potential imbalances in the baseline and clinical characteristics, patients with imperfect HAART adherence had 20-times greater risk of developing KS than patients with perfect HAART adherence [hazard ratios: 21.0, 95% confidence interval: 4.2-105.1]. Patients with low latest CD4 count (≤350cells/mm3) had a seven-times greater risk of developing KS than did their counterparts (HRs: 7.1, 95% CI: 1.4-36.2). Imperfect HAART adherence and low latest CD4 count are significantly associated with KS development.

P16.25 The incidence and associated factors of herpes zoster among hiv infected patients: a population-based retrospective cohort study in taiwan, 2000 through 2010

Introduction Highly active antiretroviral therapy (HAART) has been demonstrated to be effective in decreasing the incidence of opportunistic infections, AIDS, and death among patients with HIV infection. Herpes zoster (HZ) infection is common among patients with HIV infection. However, the impact of HAART on the incidence of HZ infection is not well understood. Methods This nationwide, population-based, retrospective cohort study was conducted using Taiwan National Health Insurance Research Database (NHIRD) from 2000–2010. The NHIRD identified 15,112 patients with HIV infection. The incidence rates were standardised according to age based on the 2000 WHO standard population. Cox proportional hazards models were used to assess the effect of HAART on the incidence of HZ infection among patients with HIV infection. Results The average incidence of the first episode of HZ after the diagnosis of HIV infection was estimated at 5.07 people/100 person-years. Multivariate Cox proportional hazards model showed that history of HZ infection (adjusted hazard ratio [aHR]: 6.76; 95% CI, 5.19–8.82) and administration of HAART (aHR: 1.53; 95% CI, 1.28–1.84) were the factors associated with HZ. Life-table method was used to divide the duration of HIV from diagnosis into two phases, namely, ≤4 years and >4 years. Initiation of HAART within 4 years of HIV diagnosis was associated with an increased risk of HZ (HR: 1.79, 95% CI: 1.48–2.16, p Conclusion With high level of HAART adherence, it had significantly lowered HZ infection risk. Therefore, we suggested emphasising the importance of early treatment and HAART adherence.

Compliance of antiviral therapy and influencing factors in people living with HIV/AIDS in Nanjing

To understand the compliance of highly active anti-retroviral therapy (HAART) and influencing factors in people living with HIV/AIDS (PLWHA) in Nanjing. PLWHA receiving HAART in No. 2 Hospital of Nanjing during May-June 2014 were recruited in this study. Self-administrated questionnaire was used to collect the data about HAART compliance and socio-demographic characteristics of PLWHA surveyed. Descriptive and multivariate statistical analysis were conducted to examine the effects of the factors on self-reported HAART adherence. A total of 276 PLWHA were surveyed, According to the evaluation criterion of Center for Adherence Support Evaluation (CASE), 252 cases showed good compliance (91.3%). logistic regression analysis revealed that smoking, progress of the disease and side effects, reminding of taking drug and age were correlated with self-reported HAART adherence. It is suggested to strengthen the education about antiviral therapy compliance in PLWHA with mild infection and those who are smokers and young, suffer from side effects, have no reminding methods for taking drug.

Factors associated with lack of viral suppression at delivery among highly active antiretroviral therapy-naive women with HIV: a cohort study.

A high delivery maternal plasma HIV-1 RNA level (viral load [VL]) is a risk factor for mother-to-child transmission and poor maternal health. To identify factors associated with detectable VL at delivery despite initiation of highly active antiretroviral therapy (HAART) during pregnancy. Multicenter observational study. (ClinicalTrial.gov: NCT00028145). 67 U.S. AIDS clinical research sites. Pregnant women with HIV who initiated HAART during pregnancy. Descriptive summaries and associations among sociodemographic, HIV disease, and treatment characteristics; pregnancy-related risk factors; and detectable VL (>400 copies/mL) at delivery. Between 2002 and 2011, 671 women met inclusion criteria and 13.1% had detectable VL at delivery. Factors associated with detectable VL included multiparity (16.4% vs. 8.0% nulliparity; P=0.002), black ethnicity (17.6% vs. 6.6% Hispanic and 6.6% white; P<0.001), 11th grade education or less (17.6% vs. 12.1% had a high school diploma; P=0.013), initiation of HAART in the third trimester (23.9% vs. 12.3% and 8.6% in the second and trimesters, respectively; P=0.003), having an HIV diagnosis before the current pregnancy (16.1% vs. 11.0% during the current pregnancy; P=0.051), and having the first prenatal visit in the third trimester (33.3% vs. 14.3% and 10.5% in the second and third trimesters, respectively; P=0.002). Women who had treatment interruptions or reported poor medication adherence were more likely to have detectable VL at delivery. Data on many covariates were incomplete because women entered the study at varying times during pregnancy. A total of 13.1% of women who initiated HAART during pregnancy had detectable VL at delivery. The timing of HAART initiation and prenatal care, along with medication adherence during pregnancy, were associated with detectable VL at delivery. Social factors, including ethnicity and education, may help identify women who could benefit from focused efforts to promote early HAART initiation and adherence. U.S. Department of Health and Human Services.

The interaction of active substance use, depression, and antiretroviral adherence in methadone maintenance.

Adherence to highly active antiretroviral therapy (HAART) remains crucial in successfully treating HIV. While active substance use and depression are both associated with each other and with HAART nonadherence, little is known about their interaction. An understanding of the interaction of substance use and depressive symptoms on HAART adherence can inform adherence-enhancing interventions as well as interventions that target substance use and depression. We tested an interaction between substance use and depression on HAART adherence among methadone maintenance patients. We assessed substance use, depressive symptoms, and HAART adherence among 100 HIV-infected individuals receiving methadone maintenance in The Bronx, New York. Regressions were performed on adherence using an interaction term comprised of substance use and depressive symptoms. MODPROBE was used to assess significant interactions. Any use of illicit substances was associated with HAART nonadherence (p = 0.043). Cannabis was the single substance of abuse most strongly associated with nonadherence (p = 0.003). Depressive symptoms approached significance in bivariate analysis (p = 0.066). In regression analysis, a significant interaction was found between illicit substance use and depressive symptoms [OR (95% CI) 1.23 (1.06-1.44), p = 0.007], where illicit substance use was associated with nonadherence in individuals with lower depressive symptoms, but not among those with depressive symptoms at higher levels. No individual substances interacted with depressive symptoms on adherence. Though substance use and depressive symptoms interacted on HAART adherence, they did not have a synergistic effect. Continued substance use (51% of the sample) suggests an unmet need for treatment, even in methadone maintenance. Further examinations of the interplay of substance use and depression on HAART adherence are warranted.

Abuse and resilience in relation to HAART medication adherence and HIV viral load among women with HIV in the United States.

Abuse is highly prevalent among HIV+ women, leading to behaviors, including lower adherence to highly active antiretroviral therapy (HAART) that result in poor health outcomes. Resilience (functioning competently despite adversity) may buffer the negative effects of abuse. This study investigated how resilience interacted with abuse history in relation to HAART adherence, HIV viral load (VL), and CD4+ cell count among a convenience sample of 138 HIV+ women from the Ruth M. Rothstein CORE Center/Cook County Health and Hospital Systems site of the Women's Interagency HIV Study (WIHS). Resilience was measured by the 10-item Connor-Davidson Resilience Scale (CD-RISC). HAART adherence (≥95% vs. <95% self reported usage of prescribed medication) and current or prior sexual, physical, or emotional/domestic abuse, were reported during structured interviews. HIV viral load (≥20 vs. <20 copies/mL) and CD4+ count (200 vs. <200 cells/mm) were measured with blood specimens. Multiple logistic regressions, controlling for age, race, income, enrollment wave, substance use, and depressive symptoms, indicated that each unit increase in resilience was significantly associated with an increase in the odds of having ≥95% HAART adherence and a decrease in the odds of having a detectable viral load. Resilience-Abuse interactions showed that only among HIV+ women with sexual abuse or multiple abuses did resilience significantly relate to an increase in the odds of ≥95% HAART adherence. Interventions to improve coping strategies that promote resilience among HIV+ women may be beneficial for achieving higher HAART adherence and viral suppression.

Expansion of HAART Coverage Is Associated with Sustained Decreases in HIV/AIDS Morbidity, Mortality and HIV Transmission: The “HIV Treatment as Prevention” Experience in a Canadian Setting

BackgroundThere has been renewed call for the global expansion of highly active antiretroviral therapy (HAART) under the framework of HIV treatment as prevention (TasP). However, population-level sustainability of this strategy has not been characterized.MethodsWe used population-level longitudinal data from province-wide registries including plasma viral load, CD4 count, drug resistance, HAART use, HIV diagnoses, AIDS incidence, and HIV-related mortality. We fitted two Poisson regression models over the study period, to relate estimated HIV incidence and the number of individuals on HAART and the percentage of virologically suppressed individuals.ResultsHAART coverage, median pre-HAART CD4 count, and HAART adherence increased over time and were associated with increasing virological suppression and decreasing drug resistance. AIDS incidence decreased from 6.9 to 1.4 per 100,000 population (80% decrease, p = 0.0330) and HIV-related mortality decreased from 6.5 to 1.3 per 100,000 population (80% decrease, p = 0.0115). New HIV diagnoses declined from 702 to 238 cases (66% decrease; p = 0.0004) with a consequent estimated decline in HIV incident cases from 632 to 368 cases per year (42% decrease; p = 0.0003). Finally, our models suggested that for each increase of 100 individuals on HAART, the estimated HIV incidence decreased 1.2% and for every 1% increase in the number of individuals suppressed on HAART, the estimated HIV incidence also decreased by 1%.ConclusionsOur results show that HAART expansion between 1996 and 2012 in BC was associated with a sustained and profound population-level decrease in morbidity, mortality and HIV transmission. Our findings support the long-term effectiveness and sustainability of HIV treatment as prevention within an adequately resourced environment with no financial barriers to diagnosis, medical care or antiretroviral drugs. The 2013 Consolidated World Health Organization Antiretroviral Therapy Guidelines offer a unique opportunity to further evaluate TasP in other settings, particularly within generalized epidemics, and resource-limited setting, as advocated by UNAIDS.

Roles of family dynamics on adherence to highly active antiretroviral therapy among people living with HIV/AIDS at a tertiary hospital in Osogbo, south-west Nigeria.

Adherence to highly active antiretroviral therapy (HAART) has been proven to be the only effective treatment for HIV/AIDS worldwide. Good adherence to HAART might require good family support. To determine the family dynamics and social support of people living with HIV/AIDS (PLWHA) and its roles on HAART adherence at an ARV treatment clinic in Osogbo, Nigeria. Descriptive cross-sectional study. Consenting PLWHA on HAART were interviewed using pre-tested semistructured questionnaire incorporating Perceived Social Support- Family Scale and Family APGAR. HAART adherence was measured using patient self report. A total of 379 PLWHA were interviewed. Their mean age was 40.8 (SD=9.9) years. Most (60.7%) were females. More than half (55.7%) were currently married and the majority (72.1%) had secondary education and were Yoruba (86.3%). Most respondents (95.5%) were adherent to HAART. Over 90% were satisfied with support received from their family while 82.3% were treated like other family members. Most attributed their HAART adherence to the care and support received from their family. Most PLWHA had good social support and were adherent to HAART.