title: Adherence among rural HIV-infected patients in the deep south: a comparison between single-tablet and multi-tablet once-daily regimens.
abstract: BACKGROUND
  Once-daily (QD), combination antiretroviral therapy (ART) can impact the willingness and ability of patients to take medications as directed. The impact of antiretroviral (ARV) drug adherence influenced by single-tablet (STR) versus multi-tablet regimens (MTR) among patients enrolled in the AIDS Drug Assistance Program (ADAP) in a rural environment has not yet been assessed.
  
  
  METHODS
  A retrospective chart review evaluated adherence and outcomes in adult HIV-infected patients enrolled in the ADAP at 2 ambulatory clinics in the Southeast, taking either a QD STR (efavirenz [EFV]/emtricitabine/tenofovir [TDF]) or a QD protease inhibitor (PI)-based, MTR (atazanavir [ATV], ritonavir [RTV], and emtricitabine/TDF) by evaluating pharmacy refill records, patient self-reported adherence, and virologic response.
  
  
  RESULTS
  A total of 389 patient records were analyzed (STR, n = 165 versus MTR, n = 224). There were more males, a higher percentage of treatment-naive patients, and more patients with a baseline CD4 count of >200 cells/mm(3) in the MTR group. Based on refill records, more patients on MTR were >90% adherent (61.6% versus 51.5%, P = .047). In a multivariable analysis, being treatment experienced was a negative predictor (odds ratio [OR] = 0.48, 0.29-0.78) for adherence. Regimen choice was not associated with adherence. More patients taking MTR were virologically suppressed at the end of the observation period. Regardless of the regimen, being >90% adherent was a significant predictor of virologic suppression (OR = 3.51, 1.98-6.23).
  
  
  CONCLUSIONS
  Treatment-experienced patients enrolled in ADAP are less likely to be adherent. A QD PI-based MTR may result in comparable adherence to an STR in a rural HIV-infected population.
authors.affiliation: Pharmacy Services Resident, University of Kentucky HealthCare, Lexington, KY, USA.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Tennant
authors.affiliation: Auburn University Harrison School of Pharmacy, Department of Pharmacy Practice Harrison School of Pharmacy, Auburn, AL, USA hesteek@auburn.edu.
authors.forename: E Kelly
authors.initials: EK
authors.lastname: Hester
authors.affiliation: South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA.
authors.forename: Celeste R
authors.initials: CR
authors.lastname: Caulder
authors.affiliation: South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA.
authors.forename: Z Kevin
authors.initials: ZK
authors.lastname: Lu
authors.affiliation: South Carolina College of Pharmacy, University of South Carolina, Columbia, SC, USA.
authors.forename: P Brandon
authors.initials: PB
authors.lastname: Bookstaver
mesh_terms: D000328:Adult; D000407:Alabama / Q000453:epidemiology; D019380:Anti-HIV Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019035:Rural Health Services; D012424:Rural Population; D013022:South Carolina / Q000453:epidemiology; D019562:Viral Load; D016903:Drug Monitoring
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; adherence; antiretroviral agents; protease inhibitor; rural health services