Adherence to highly-active antiretroviral therapies in HIV-infected veterans

Persistent Link:
http://hdl.handle.net/10150/284013
Title:
Adherence to highly-active antiretroviral therapies in HIV-infected veterans
Author:
Mohler, Martha Jane
Issue Date:
1999
Publisher:
The University of Arizona.
Rights:
Copyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.
Abstract:
Objective. To describe patient variables associated with adherence to Highly Active Antiretroviral Therapies (HAART) in the Tucson VA HIV Clinic. Methods. A cross-sectional study of sixty-seven HIV-infected veterans on HAART regimens (two protease inhibitors or three or more antiretroviral medications) examined theorized patient, patient-provider and regimen predictors related to: HIV RNA viral load, one-month monitored adherence of one antiretroviral medication within the HAART regimen via Medication Event Monitoring System cap percent therapeutic coverage (%TC-ADH), and self-reported adherence (SR-ADH). Sixty-seven subjects completed self-report, and sixty MEMS Cap data. Results. Subjects were male, white (78%), gay (54%) and/or intravenous drug using (31%), and educated (70% completed high school). Forty-three percent had an AIDS diagnosis, and antiretroviral history averaged five years. Thirty-five of sixty-seven (52%) had an HIV RNA ≤50 copies (undetectable). Forty-one of sixty (68%) had %TC-ADH ≥90%, and 41/67 (62%) had 100% SR-ADH over the previous 7 days. %TC-ADH and SR-ADH were correlated (r = .56 p < .0001). SR-ADH ≥90% was associated with an undetectable viral load (OR 3.3, CI 1.2-9.2). There was a trend toward an association between MEMS-ADH as a continuous variable and log viral load (P = 0.074). %TC-ADH ≥90% was not associated with viral suppression (OR 1.2, CI .39-3.5). Disruption of pilltaking by activities of daily living was associated with a six-fold increased risk of viral load >50 copies (OR 5.9, CI 1.4-24.8). Belief in one's ability to take medication as ordered (OR 32 CI 4.4-234) was highly associated with SR-ADH ≥90%. Employment was associated with lower odds of SR-ADH ≥90% (OR 0.12, CI .02-.67). Non-white subjects had lower odds of %TC-ADH ≥90% (OR 0.18, CI .04-.93). A 10-point higher score on the HIV-MOS energy/fatigue scale (OR 1.46, CI 1.04-2.4), and belief in ability to take medication as ordered (OR 2.5, CI 1.20-5.0), were associated with greater odds of %TC-ADH ≥90%. Conclusions. SR-ADH was associated with HIV RNA viral load. Less than 62% of patients adhered at ≥90% based upon SR and %TC-ADH. Disruption of medication-taking by activities of daily living, and poor self-efficacy may negatively affect adherence. Assessment of patient beliefs in their ability to take medications as ordered may be a clinically useful adherence screening question.
Type:
text; Dissertation-Reproduction (electronic)
Keywords:
Health Sciences, Public Health.; Health Sciences, Immunology.
Degree Name:
Ph.D.
Degree Level:
doctoral
Degree Program:
Graduate College; Epidemiology
Degree Grantor:
University of Arizona
Advisor:
Lebowitz, Michael D.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_US
dc.titleAdherence to highly-active antiretroviral therapies in HIV-infected veteransen_US
dc.creatorMohler, Martha Janeen_US
dc.contributor.authorMohler, Martha Janeen_US
dc.date.issued1999en_US
dc.publisherThe University of Arizona.en_US
dc.rightsCopyright © is held by the author. Digital access to this material is made possible by the University Libraries, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author.en_US
dc.description.abstractObjective. To describe patient variables associated with adherence to Highly Active Antiretroviral Therapies (HAART) in the Tucson VA HIV Clinic. Methods. A cross-sectional study of sixty-seven HIV-infected veterans on HAART regimens (two protease inhibitors or three or more antiretroviral medications) examined theorized patient, patient-provider and regimen predictors related to: HIV RNA viral load, one-month monitored adherence of one antiretroviral medication within the HAART regimen via Medication Event Monitoring System cap percent therapeutic coverage (%TC-ADH), and self-reported adherence (SR-ADH). Sixty-seven subjects completed self-report, and sixty MEMS Cap data. Results. Subjects were male, white (78%), gay (54%) and/or intravenous drug using (31%), and educated (70% completed high school). Forty-three percent had an AIDS diagnosis, and antiretroviral history averaged five years. Thirty-five of sixty-seven (52%) had an HIV RNA ≤50 copies (undetectable). Forty-one of sixty (68%) had %TC-ADH ≥90%, and 41/67 (62%) had 100% SR-ADH over the previous 7 days. %TC-ADH and SR-ADH were correlated (r = .56 p < .0001). SR-ADH ≥90% was associated with an undetectable viral load (OR 3.3, CI 1.2-9.2). There was a trend toward an association between MEMS-ADH as a continuous variable and log viral load (P = 0.074). %TC-ADH ≥90% was not associated with viral suppression (OR 1.2, CI .39-3.5). Disruption of pilltaking by activities of daily living was associated with a six-fold increased risk of viral load >50 copies (OR 5.9, CI 1.4-24.8). Belief in one's ability to take medication as ordered (OR 32 CI 4.4-234) was highly associated with SR-ADH ≥90%. Employment was associated with lower odds of SR-ADH ≥90% (OR 0.12, CI .02-.67). Non-white subjects had lower odds of %TC-ADH ≥90% (OR 0.18, CI .04-.93). A 10-point higher score on the HIV-MOS energy/fatigue scale (OR 1.46, CI 1.04-2.4), and belief in ability to take medication as ordered (OR 2.5, CI 1.20-5.0), were associated with greater odds of %TC-ADH ≥90%. Conclusions. SR-ADH was associated with HIV RNA viral load. Less than 62% of patients adhered at ≥90% based upon SR and %TC-ADH. Disruption of medication-taking by activities of daily living, and poor self-efficacy may negatively affect adherence. Assessment of patient beliefs in their ability to take medications as ordered may be a clinically useful adherence screening question.en_US
dc.typetexten_US
dc.typeDissertation-Reproduction (electronic)en_US
dc.subjectHealth Sciences, Public Health.en_US
dc.subjectHealth Sciences, Immunology.en_US
thesis.degree.namePh.D.en_US
thesis.degree.leveldoctoralen_US
thesis.degree.disciplineGraduate Collegeen_US
thesis.degree.disciplineEpidemiologyen_US
thesis.degree.grantorUniversity of Arizonaen_US
dc.contributor.advisorLebowitz, Michael D.en_US
dc.identifier.proquest9957954en_US
dc.identifier.bibrecord.b40137788en_US
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