title: Patients' perceptions of highly active antiretroviral therapy in relation to treatment uptake and adherence: the utility of the necessity-concerns framework.
abstract: OBJECTIVE
  To test the utility of the necessity-concerns framework in predicting highly active antiretroviral therapy (HAART) uptake and adherence.
  
  
  METHODS
  This was a prospective follow-up study. Consecutive patients who were not currently receiving HAART were referred by their HIV physician. Immediately after a recommendation of HAART, patients completed the Beliefs about Medicines Questionnaire assessing their perceptions of personal necessity for HAART and concerns about potential adverse effects. The influence of these beliefs on the decision to accept or decline HAART and adherence 12 months later were assessed.
  
  
  RESULTS
  One hundred fifty-three participants were given a recommendation of HAART, and 136 (88.9%) returned completed questionnaires. Thirty-eight participants (28%) initially rejected the treatment offer. Uptake of HAART was associated with perceptions of personal necessity for treatment (odds ratio [OR]=7.41, 95% confidence interval [CI]: 2.84 to 19.37) and concerns about potential adverse effects (OR=0.19, 95% CI: 0.07 to 0.48). There was a significant decline in adherence over time. Perceived necessity (OR=2.19, 95% CI: 1.02 to 4.71) and concerns about adverse effects (OR=0.45, 95% CI: 0.22 to 0.96), elicited before initiating HAART, predicted subsequent adherence. These associations were independent of clinical variables and depression.
  
  
  CONCLUSIONS
  The necessity-concerns framework is a useful theoretic model for understanding patient perspectives of HAART and predicting uptake and adherence, with implications for the design of evidence-based interventions.
authors.affiliation: Centre for Behavioural Medicine, Department of Policy and Practice, The School of Pharmacy, University of London, and Brighton University Hospital, National Health Service Trust, The Lawson Unit, United Kingdom. rob.horne@pharmacy.ac.uk
authors.forename: Robert
authors.initials: R
authors.lastname: Horne
authors.forename: Vanessa
authors.initials: V
authors.lastname: Cooper
authors.forename: Grace
authors.initials: G
authors.lastname: Gellaitry
authors.forename: Heather Leake
authors.initials: HL
authors.lastname: Date
authors.forename: Martin
authors.initials: M
authors.lastname: Fisher
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D006678:HIV; D015658:HIV Infections / Q000188:drug therapy; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D010349:Patient Compliance; D011795:Surveys and Questionnaires; D016312:Treatment Refusal; D006113:United Kingdom
chemical_list: D019380:Anti-HIV Agents