Theory-guided, empirically supported avenues for intervention on HIV medication nonadherence: findings from the Healthy Living Project.
OBJECTIVE
Adherence to antiretroviral therapy (ART) remains a challenge in efforts to maximize HIV treatment benefits. Previous studies of antiretroviral adherence are limited by low statistical power, homogeneous samples, and biased assessment methods. Based on Social Action Theory and using a large, diverse sample of men and women living with HIV, the objectives of the current study are to clarify correlates of nonadherence to ART and to provide theory-guided, empirically supported direction for intervening on ART nonadherence.


METHODS
Cross-sectional interview study utilizing a computerized interview.


METHODS
Recruited from clinics, agencies, and via media ads in four U.S. cities from June 2000 to January 2002.


METHODS
Two thousand seven hundred and sixty-five HIV-positive adults taking ART.


METHODS
Computer-assessed self-reported antiretroviral adherence.


RESULTS
Thirty-two percent reported less than 90% adherence to ART in the prior 3 days. A number of factors were related to nonadherence in univariate analysis. Multivariate analyses identified that being African American, being in a primary relationship, and a history of injection drug use or homelessness in the past year were associated with greater likelihood of nonadherence. Furthermore, adherence self-efficacy, and being able to manage side effects and fit medications into daily routines were protective against nonadherence. Being tired of taking medications was associated with poorer adherence whereas a belief that nonadherence can make the virus stronger was associated with better adherence.


CONCLUSIONS
Results support the need for multifocused interventions to improve medication adherence that address logistical barriers, substance use, attitudes and expectancies, as well as skills building and self-efficacy enhancement. Further exploration of issues related to adherence for African Americans and men in primary relationships is warranted.
Johnson
Mallory O
MO
Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, California 94105, USA. Mjohnson@psg.ucsf.edu
Catz
Sheryl L
SL
Remien
Robert H
RH
Rotheram-Borus
Mary Jane
MJ
Morin
Stephen F
SF
Charlebois
Edwin
E
Gore-Felton
Cheryl
C
Goldsten
Rise B
RB
Wolfe
Hannah
H
Lightfoot
Marguerita
M
Chesney
Margaret A
MA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007407:Interviews as Topic; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D012495:San Francisco / Q000453:epidemiology; D012944:Social Support; D016312:Treatment Refusal / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014922:Wisconsin / Q000453:epidemiology
D019380:Anti-HIV Agents