title: Factors associated with adherence to highly active antiretroviral therapy in homeless or unstably housed adults living with HIV.
abstract: The aim of this study is to investigate adherence to highly active antiretroviral therapy (HAART) in persons living with HIV/AIDS (PLWHA) who are homeless or unstably housed. We evaluated homeless or unstably housed PLWHA (n=644) in three US cities were enrolled in the Housing and Health Study. Using baseline data and controlling for gender, race, age, and education, we examined associations between self-reported two- and Seven-day adherence and access to healthcare, mental health, substance use, and attitudes toward HIV medical therapy. Of the 644 participants, 358 (55%) were currently on HAART. For two-day adherence, 280 (78%) reported missing no prescribed doses (100% adherence), and for seven-day adherence, 291 (81%) reported > or =90% adherence. Logistic regression analyses indicated being younger, not having health insurance, and drug use were associated with missing > or =1 dose over the past two days. Scoring lower on SF-36 mental component summary scale and having greater risk of depression (CES-D) and stress (Perceived Stress Scale) were associated with poorer adherence for both two- and seven-day outcomes. Negative attitudes toward HIV treatment were also associated with lower adherence. Adherence to HIV medications in this population is similar to other groups. Coexisting problems of access to healthcare, higher risk of mental health problems, along with poorer attitudes toward treatment are associated with increased likelihood of missing doses. Comprehensive models of HIV care that include a continuum of medical and social services are essential for treating this population.
authors.affiliation: Abt Associates Inc., Bethesda, MD, USA. scott_royal@abtassoc.com
authors.forename: Scott W
authors.initials: SW
authors.lastname: Royal
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Kidder
authors.forename: Satyendra
authors.initials: S
authors.lastname: Patrabansh
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wolitski
authors.forename: David R
authors.initials: DR
authors.lastname: Holtgrave
authors.forename: Angela
authors.initials: A
authors.lastname: Aidala
authors.forename: Sherri
authors.initials: S
authors.lastname: Pals
authors.forename: Ron
authors.initials: R
authors.lastname: Stall
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000209:etiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006297:Health Services Accessibility; D006703:Ill-Housed Persons / Q000523:psychology*; D006798:Housing; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D012044:Regression Analysis; D015819:Substance Abuse, Intravenous / Q000523:psychology; D055815:Young Adult