title: Adherence to highly active antiretroviral therapy in HIV-infected inmates.
abstract: Adherence to highly active antiretroviral therapy (HAART) has been scarcely studied in correctional settings. Our study aims to evaluate the relationship between adherence and virological outcome and to determine factors related to adherence in correctional settings. A cross-sectional retrospective study was performed in Topas prison (Salamanca, Spain). 50 inmates starting HAART were studied. Adherence was estimated through a self-report questionnaire and variables related to adherence (covering individual factors, the illness itself and the therapeutic regimen) were recorded. HIV-RNA levels and CD4 lymphocyte count were measured before starting therapy and six months after. Statistical analysis was performed using univariate and multivariate methods. 21 inmates (42%) were considered adherent and 29 (58%) were non-adherent. Adherence to treatment, as measured by our questionnaire, was the only significant and independent factor associated with an undetectable viral load at six months of therapy. Five variables were significantly associated with adherence to treatment, four of them as predictor factors for good adherence: an active occupation inside prison, the absence of HIV-related symptoms, a good or average acceptance of treatment, and a higher academic background; previous injection drug use as a risk factor for HIV transmission was associated with non-adherence. A simple self-report questionnaire may be useful for assessing adherence in prison inmates. Recognizing variables associated with adherence is essential to identify prisoners at high risk of being non-adherents in order to develop strategies for improving compliance.
authors.affiliation: Department of Internal Medicine, University Hospital of Salamanca, Salamanca, Spain.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Inés
authors.forename: Leticia
authors.initials: L
authors.lastname: Moralejo
authors.forename: Miguel
authors.initials: M
authors.lastname: Marcos
authors.forename: Aurelio
authors.initials: A
authors.lastname: Fuertes
authors.forename: Guillermo
authors.initials: G
authors.lastname: Luna
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000276:immunology / Q000821:virology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011330:Prisons; D012367:RNA, Viral / Q000097:blood; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D016312:Treatment Refusal; D019562:Viral Load
chemical_list: D012367:RNA, Viral