Predictors for non-adherence to antiretroviral therapy
K. J. Wilson A , A. Doxanakis A and C. K. Fairley A BA Department of Public Health, The University of Melbourne, Parkville, Vic. 3010, Australia.
B Melbourne Sexual Health Centre, 580 Swanston Street, Carlton, Vic. 3053, Australia. Corresponding author. Email: cfairley@unimelb.edu.au
Sexual Health 1(4) 251-257 https://doi.org/10.1071/SH04020
Submitted: 4 June 2004 Accepted: 16 November 2004 Published: 21 December 2004
Abstract
Objectives: To determine the risk factors for non-adherence to antiretroviral therapy. Methods: Two hundred clients attending the Melbourne Sexual Health Centre completed a questionnaire about lifestyle, self-efficacy, depression, drug or alcohol use, social supports, and attitudes to health care. Self-reported adherence (SRA) was measured by missed doses in the last 4, 7 and 28 days. Routinely collected viral load levels were reviewed. Results: Two hundred (85%) out of 231 eligible clients participated in the study. Viral load was most strongly associated with SRA for the last 28 days (P < 0.001). Non-adherence was defined as <98.2% SRA. Non-adherence was most strongly associated with having regular daily routines [odds ratio and 95% confidence interval = 0.4 (0.2, 0.7], having set times for getting up and going to bed [0.5 (0.3, 1.0)], using marijuana more than 4 times per week [0.4 (0.2, 1.0)] and lower self-efficacy which included; being sure that you will be able to take medications as directed [0.2 (0.1, 0.6)] and being sure that missing doses of HIV medication will result in drug resistance [0.4 (0.2, 0.7)]. When significant questions were combined into a composite score to screen for non-adherence, the sensitivity to predict non-adherence was as high as 71% with a specificity of 59%. Conclusions : This study showed that a 10-min questionnaire was associated with clients past non-adherence to antiretroviral therapy and may be useful for predicting future adherence.
Additional keywords: adherence, HIV.
Acknowledgements
Thank you to Jeanette Venkataya and Kerri Boyd for assistance in recruiting study participants and to Tim Kuo who accessed relevant data from clinical databases. Thank you also to Tim Read and Norm Roth who assisted in data collection and to Christopher Thomas who assisted in accessing pharmacy data. Thank you to Jane Hocking, Catherine Bennet and Doreen Rosenthal for helpful advice on appropriate statistical analysis. We also are grateful for the use of previously used questionnaires; Australian Society of HIV Medicine (ASHM) lifestyle checklist, AIDS Clinical Trials Group (ACTG) Adherence Baseline Questionnaire, The Medication Adherence Checklist and The Centre for Epidemiological Studies Depression Study (CES-D).
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