Financial stress is associated with reduced treatment adherence in HIV-infected adults in a resource-rich setting.
OBJECTIVE
Financial stress has been identified as a barrier to antiretroviral adherence, but only in resource- limited settings. Almost half of HIV-infected Australian adults earn no regular income and, despite highly subsidised antiretroviral therapy and universal health care, 3% of HIV-infected Australians cease antiretroviral therapy each year. We studied the relationship between financial stress and treatment adherence in a resource-rich setting.


METHODS
Out-patients attending the HIV clinic at St Vincent's Hospital between November 2010 and May 2011 were invited to complete an anonymous survey including questions relating to costs and adherence.


RESULTS
Of 335 HIV-infected patients (95.8% male; mean age 52 years; hepatitis coinfection 9.2%), 65 patients (19.6%) stated that it was difficult or very difficult to meet pharmacy dispensing costs, 49 (14.6%) reported that they had delayed purchasing medication because of pharmacy costs, and 30 (9.0%) reported that they had ceased medication because of pharmacy costs. Of the 65 patients with difficulties meeting pharmacy costs, 19 (29.2%) had ceased medication vs. 11 (4.1%) of the remaining 270 patients (P < 0.0001). In addition, 19 patients (5.7%) also stated that it was difficult or very difficult to meet travel costs to the clinic. Treatment cessation and interruption were both independently associated with difficulty meeting both pharmacy and clinic travel costs. Only 4.9% had been asked if they were having difficulty paying for medication.


CONCLUSIONS
These are the first data to show that pharmacy dispensing and clinic travel costs may affect treatment adherence in a resource-rich setting. Patients should be asked if financial stress is limiting their treatment adherence.
HIV, Immunology and Infectious Diseases Unit, and Clinical Research Program, Centre for Applied Medical Research, St Vincent's Hospital, Sydney, NSW, Australia.
J
J
McAllister
G
G
Beardsworth
E
E
Lavie
K
K
MacRae
A
A
Carr
D017088:AIDS-Related Opportunistic Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000191:economics; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D003157:Community Pharmacy Services / Q000191:economics*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D017048:Health Care Costs; D006297:Health Services Accessibility; D006525:Hepatitis, Viral, Human / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
D019380:Anti-HIV Agents