title: Adherence to antiretroviral medications and medical care in HIV-infected adults diagnosed with mental and substance abuse disorders.
abstract: This paper examines factors associated with adherence to antiretroviral medications (ARVs) in an HIV-infected population at high risk for non-adherence: individuals living with psychiatric and substance abuse disorders. Data were examined from baseline interviews of a multisite cohort intervention study of 1138 HIV-infected adults with both a psychiatric and substance abuse disorder (based on a structured psychiatric research interview using DSM-IV criteria). The baseline interview documented mental illness and substance use in the past year, mental illness and substance abuse severity, demographics, service utilization in the past three months, general health and HIV-related conditions, self-reported spirituality and self-reported ARV medication use. Among the participants, 62% were prescribed ARVs at baseline (n = 542) and 45% of those on ARVs reported skipping medications in the past three days. Reports of non-adherence were significantly associated with having a detectable viral load (p<.01). The factors associated with non-adherence were current drug and alcohol abuse, increased psychological distress, less attendance at medical appointments, non-adherence to psychiatric medications and lower self-reported spirituality. Increased psychological distress was significantly associated with non-adherence, independent of substance abuse (p<.05). The data suggest that both mental illness and substance use must be addressed in HIV-infected adults living with these co-morbid illnesses to improve adherence to ARVs.
authors.affiliation: HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, USA. cam14@columbia.edu
authors.forename: Claude Ann
authors.initials: CA
authors.lastname: Mellins
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Havens
authors.forename: Cheryl
authors.initials: C
authors.lastname: McDonnell
authors.forename: Carolyn
authors.initials: C
authors.lastname: Lichtenstein
authors.forename: Karina
authors.initials: K
authors.lastname: Uldall
authors.forename: Margaret
authors.initials: M
authors.lastname: Chesney
authors.forename: E Karina
authors.initials: EK
authors.lastname: Santamaria
authors.forename: James
authors.initials: J
authors.lastname: Bell
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D019033:Delivery of Health Care, Integrated / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000150:complications; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents