Changes in adherence to highly active antiretroviral therapy medications in the Multicenter AIDS Cohort Study.
OBJECTIVE
To characterize the determinants of changes in adherence to antiretroviral therapy and examine whether there are persistent lower adherers.


METHODS
A cohort study with repeated measurements.


METHODS
Self-reported 100% adherence was defined as taking all doses and numbers of pills over a 4-day period as prescribed for current HIV medications. Independent predictors of changing adherence (< 100% to 100% and 100% to < 100%) were determined by logistic regression, correcting for correlated repeated measures for 597 HIV-positive men reporting the use of highly active antiretroviral therapy (HAART) between October 1998 and October 2000.


RESULTS
Of the 942 visit-pairs with initial 100% adherence, 106 (11.3%) reduced adherence to less than 100%, and 836 (88.7%) remained 100% adherent at the next 6-month visit. No recent outpatient visits, younger age, depression, less than college educated, and later in calendar time predicted decreasing adherence. Among 186 visit-pairs starting with less than 100% adherence, 133 (71.5%) improved adherence to 100% and 53 (28.5%) remained less than 100% adherent at the next visit. The determinants of improving adherence included not being African-American, not using recreational drugs, and having had more than three HAART regimens. Lower adherence was not a random event; it was significantly correlated across visits within the individual.


CONCLUSIONS
Characteristics associated with improving and lowering adherence differed and should be considered in developing interventions to enhance adherence and optimize effective therapies.
Kleeberger
Cynthia A
CA
Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Buechner
Jennifer
J
Palella
Frank
F
Detels
Roger
R
Riddler
Sharon
S
Godfrey
Rebecca
R
Jacobson
Lisa P
LP
D000328:Adult; D001741:Black or African American / Q000523:psychology; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology* / Q000706:statistics & numerical data*; D015331:Cohort Studies; D004812:Epidemiologic Methods; D015658:HIV Infections / Q000188:drug therapy* / Q000208:ethnology; D015497:HIV-1; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000208:ethnology / Q000706:statistics & numerical data*; D014481:United States