title: Highly active antiretroviral therapy: physician experience and enhanced adherence to prescription refill.
abstract: OBJECTIVE
  To identify patient and physician characteristics that may act as determinants of adherence to prescription refill of triple combination antiretroviral therapy.
  
  
  METHODS
  A population-based analysis of antiretroviral therapy-naive HIV-positive men and women in British Columbia, Canada, who initiated triple combination therapy between August 1 1996 and October 31 1998. Study participants were considered adherent if they were actually dispensed antiretrovirals > or = 95% over the first year of therapy. Log-binomial regression was used to identify patient and physician characteristics associated with adherence to prescription refill.
  
  
  RESULTS
  Of the 886 individuals eligible for analysis, 495 (56%) were > or = 95% adherent to prescription refill. In multivariate analysis, adherence was positively associated with increased age [adjusted relative rate (ARR) 1.19; 95% CI: 1.07-1.32], having a diagnosis of AIDS (ARR 1.66; 95% CI: 1.29-2.15), being male (ARR 1.79; 95% CI: 1.27-2.53), and with greater experience of the treating physician (ARR 1.27; 95% CI: 1.13-1.42). History of injection drug use was negatively associated with adherence to prescription refill (ARR 0.65; 95% CI: 0.51-0.83), as was increased pill burden (per pill daily) (ARR 0.95; 95% CI: 0.92-0.99). A sub-analysis of 316 patients who provided additional data regarding psychosocial characteristics indicated that adherence was positively associated with physician experience (ARR: 1.28; 95% CI: 1.09-1.51) and being employed (ARR: 1.55; 95% CI: 1.14-2.21), and negatively associated with a history of injection drug use (ARR: 0.61; 95% CI: 0.43-0.85).
  
  
  CONCLUSIONS
  While patient disease stage and personal characteristics may play an important role in patient adherence to prescription refill of complex therapeutic regimens, our findings indicate that HIV-experienced physicians may have greater success in maintaining patients on prescribed therapy.
authors.affiliation: BC Centre for Excellence in HIV/AIDS, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Juan
authors.initials: J
authors.lastname: Delgado
authors.forename: Katherine V
authors.initials: KV
authors.lastname: Heath
authors.forename: Benita
authors.initials: B
authors.lastname: Yip
authors.forename: Stephen
authors.initials: S
authors.lastname: Marion
authors.forename: Victoria
authors.initials: V
authors.lastname: Alfonso
authors.forename: Julio S G
authors.initials: JS
authors.lastname: Montaner
authors.forename: Michael V
authors.initials: MV
authors.lastname: O'Shaughnessy
authors.forename: Robert S
authors.initials: RS
authors.lastname: Hogg
mesh_terms: D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D002983:Clinical Competence; D003710:Demography; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance; D015819:Substance Abuse, Intravenous / Q000150:complications