title: Reasons for non-adherence to antiretroviral therapy: patients' perspectives provide evidence of multiple causes.
abstract: The objective of the study was to define common reasons for non-adherence (NA) to highly active antiretroviral therapy (HAART) and the number of reasons reported by non-adherent individuals. A confidential questionnaire was administered to HIV-seropositive patients taking proteinase inhibitor based HAART. Median self-reported adherence was 95% (n = 178, range = 60-100%). The most frequent reasons for at least 'sometimes' missing a dose were eating a meal at the wrong time (38.2%), oversleeping (36.3%), forgetting (35.0%) and being in a social situation (30.5%). The mean number of reasons occurring at least 'sometimes' was 3.2; 20% of patients gave six or more reasons; those reporting the lowest adherence reported a significantly greater numbers of reasons (rho = - 0.59; p < 0.001). Three factors were derived from the data by principal component analysis reflecting 'negative experiences of HAART', 'having a low priority for taking medication' and 'unintentionally missing doses', accounting for 53.8% of the variance. On multivariate analysis only the latter two factors were significantly related to NA (odds ratios 0.845 and 0.849, respectively). There was a wide spectrum of reasons for NA in our population. The number of reasons in an individual increased as adherence became less. A variety of modalities individualized for each patient are required to support patients with the lowest adherence.
authors.affiliation: St. Stephen's Centre, Chelsea & Westminster Healthcare NHS Trust, London, UK.
authors.forename: J C
authors.initials: JC
authors.lastname: Walsh
authors.forename: R
authors.initials: R
authors.lastname: Horne
authors.forename: M
authors.initials: M
authors.lastname: Dalton
authors.forename: A P
authors.initials: AP
authors.lastname: Burgess
authors.forename: B G
authors.initials: BG
authors.lastname: Gazzard
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy / Q000523:psychology; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000009:adverse effects*; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D008297:Male; D011939:Mental Recall; D015999:Multivariate Analysis; D016017:Odds Ratio; D011795:Surveys and Questionnaires; D016312:Treatment Refusal