Factors associated with antiretroviral therapy adherence and medication errors among HIV-infected injection drug users.
BACKGROUND
Active drug use is often associated with poor adherence, but few studies have determined psychosocial correlates of adherence in injection drug users (IDUs).


METHODS
Of 1161 Intervention for Seropositive Injectors-Research and Evaluation study enrollees, 636 were taking antiretrovirals. We assessed self-reported adherence to self-reported antiretroviral regimens and medication errors, which we defined as daily doses that were inconsistent with standard or alternative antiretroviral prescriptions.


RESULTS
Most subjects (75%, n=477) self-reported good (>or=90%) adherence, which was strongly associated with an undetectable viral load. Good adherence was independently associated with being a high school graduate, not sharing injection equipment, fewer depressive symptoms, positive attitudes toward antiretrovirals, higher self-efficacy for taking antiretrovirals as prescribed, and greater sense of responsibility to protect others from HIV. Medication errors were made by 54% (n=346) and were strongly associated with a detectable viral load and fewer CD4 cells. Errors were independently associated with nonwhite race and with depressive symptoms, poorer self-efficacy for safer drug use, and worse attitudes toward HIV medications.


CONCLUSIONS
Modifiable factors associated with poor adherence, including depressive symptoms and poor self-efficacy, should be targeted for intervention. Because medication errors are prevalent and associated with a detectable viral load and fewer CD4 cells, interventions should include particular efforts to identify medication taking inconsistent with antiretroviral prescriptions.
Arnsten
Julia H
JH
Division of General Internal Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY 10467, USA. jarnsten@montefiore.org
Li
Xuan
X
Mizuno
Yuko
Y
Knowlton
Amy R
AR
Gourevitch
Marc N
MN
Handley
Kathleen
K
Knight
Kelly R
KR
Metsch
Lisa R
LR
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008508:Medication Errors; D010349:Patient Compliance; D012307:Risk Factors; D012650:Self Disclosure; D015819:Substance Abuse, Intravenous / Q000150:complications*; D014481:United States / Q000453:epidemiology; D019562:Viral Load
D019380:Anti-HIV Agents