Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status.
OBJECTIVE
Although most agree that poor adherence to antiretrovirals is a common problem, relatively few factors have been shown to consistently predict treatment failure. In this study, a theoretical framework encompassing demographic characteristics, health beliefs/attitudes, treatment self-efficacy, and neurocognitive status was examined in relationship to highly active antiretroviral therapy adherence.


METHODS
Prospective, cross-sectional observational design.


METHODS
Neuropsychological test performance, health beliefs and attitudes, and medication adherence tracked over a 1-month period using electronic monitoring technology (Medication Event Monitoring System caps).


RESULTS
The rate of poor adherence was twice as high among younger participants than with older participants (68% and 33%, respectively). Results of binary logistic regression revealed that low self-efficacy and lack of perceived treatment utility predicted poor adherence among younger individuals, whereas decreased levels of neurocognitive functioning remained the sole predictor of poor adherence among older participants.


CONCLUSIONS
These data support components of the health beliefs model in predicting medication adherence among younger HIV-positive individuals. However, risk of adherence failure in those ages 50 years and older appears most related to neurocognitive status.
Barclay
Terry R
TR
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA 90095, USA. tbarclay@mednet.ucla.edu
Hinkin
Charles H
CH
Castellon
Steven A
SA
Mason
Karen I
KI
Reinhard
Matthew J
MJ
Marion
Sarah D
SD
Levine
Andrew J
AJ
Durvasula
Ramani S
RS
D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D001294:Attitude to Health; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003469:Culture; D005260:Female; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000523:psychology*; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D012307:Risk Factors; D020377:Self Efficacy; D016312:Treatment Refusal / Q000523:psychology*