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Sabino TE, Avelino-Silva VI, Cavalcantte C, Goulart SP, Luiz OC, Fonseca LAM, Casseb JS. Adherence to antiretroviral treatment and quality of life among transgender women living with HIV/AIDS in São Paulo, Brazil. AIDS Care 2020; 33:31-38. [PMID: 31906696 DOI: 10.1080/09540121.2019.1710449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study focused on factors associated with antiretroviral therapy (ART) adherence and quality of life among transgenderwomen in Sao Paulo, Brazil, using univariable and adjusted analysis. Adherence was evaluated with a self-report tool and with HIV viral load (VL) measurement. PROQOL-HIV was used to assess quality of life. 106 TGW with median 41 years old were included; most were white (56%) and had >10 years of education (57%). Median time since HIV/AIDS diagnosis was 10 years. Overall, participants had high T CD4+ counts (median 659 cells/mm3) and most (75%) had undetectable HIV VL. 85% were considered adherent using self-report (95%CI 77-91), whereas 72% (95%CI 62-80) were considered adherent when self-report and undetectable HIV VL were analyzed jointly. Older age was associated with higher ART adherence; each year increase in age was associated with 5% higher odds of adherence (p = 0.021). Quality of life ranged from good-excellent in 5 of 8 domains. Younger age, lower education, higher time since HIV diagnosis, comorbidities, illicit drugs use and depression were associated with lower PROQOL scores in specific domains in univariable analysis, while depression was also associated with lower total PROQOL score even after adjustment for age, comorbidities and time since HIV diagnosis (p = 0.048).
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Affiliation(s)
- Thiago E Sabino
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
| | - Vivian I Avelino-Silva
- Department of Infectious and Parasitic Diseases, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Clara Cavalcantte
- School of Public Health, Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brazil
| | - Silvia P Goulart
- HIV/AIDS Reference and Treatment Center in São Paulo, Centro de Referência e Tratamento de DST Aids, São Paulo, Brazil
| | - Olinda C Luiz
- Departament of Preventive Medicine, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Luiz A M Fonseca
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
| | - Jorge S Casseb
- Institute of Tropical Medicine, Universidade de São Paulo, São Paulo, USA
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Etefia E, Ben S, Inyang-Etoh P. Assessments of the level of adherence to antiretroviral therapy and the health status of people living with HIV in Calabar, Nigeria. CHRISMED JOURNAL OF HEALTH AND RESEARCH 2020. [DOI: 10.4103/cjhr.cjhr_84_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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The Role of Emotional Avoidance, the Patient-Provider Relationship, and Other Social Support in ART Adherence for HIV+ Individuals. AIDS Behav 2018; 22:929-938. [PMID: 28265805 DOI: 10.1007/s10461-017-1745-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Adherence to antiretroviral therapy (ART) is associated with positive health outcomes among HIV+ patients. However, non-adherence remains high. Though factors that account for non-adherence remain unclear, social support has been consistently associated with ART adherence. As such, identifying malleable factors that hinder patients' ability to form supportive relationships may have consequence for improving ART adherence. Emotional avoidance (EA) may be one such factor given that it has been linked to difficulties in social situations. The present study examined relations among EA, the patient-provider relationship, other sources of social support, and ART adherence within a sample of HIV+ ART-prescribed patients. High EA was related to poor adherence and patient-provider relationships. EA was indirectly related to poor adherence through poorer patient-provider interactions. The indirect relation of EA to ART adherence through other sources of social support was not significant. Implications for developing targeted behavioral interventions focused on improving ART adherence are discussed.
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Jayaweera D, DeJesus E, Nguyen KL, Grimm K, Butcher D, Seekins DW. Virologic Suppression, Treatment Adherence, and Improved Quality of Life on a Once-Daily Efavirenz-Based Regimen in Treatment-Naïve HIV-1–Infected Patients Over 96 Weeks. HIV CLINICAL TRIALS 2015; 10:375-84. [DOI: 10.1310/hct1006-375] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chabikuli NO, Datonye DO, Nachega J, Ansong D. Adherence to antiretroviral therapy, virologic failure and workload at the Rustenburg Provincial Hospital. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786204.2010.10874005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Évaluation clinique de l’adhésion au traitement antirétroviral chez des adolescents infectés par le VIH depuis la petite enfance. Arch Pediatr 2013; 20:348-55. [DOI: 10.1016/j.arcped.2013.01.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 12/17/2012] [Accepted: 01/07/2013] [Indexed: 11/19/2022]
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A cost analysis of an Internet-based medication adherence intervention for people living with HIV. J Acquir Immune Defic Syndr 2012; 60:1-4. [PMID: 22362156 DOI: 10.1097/qai.0b013e318250f011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The purpose of the study was to document development costs and estimate implementation costs of an Internet-based medication adherence intervention for people living with HIV in the United States. Participants (n = 61) were enrolled in the 8-week study in 2011 and entered the intervention website remotely in the setting of their choice. Development costs were obtained from a feasibility and acceptability study of an Internet-based medication adherence intervention. Implementation costs were estimated based on an 8-week trial period during the feasibility and acceptability study. Results indicated that although developing an Internet-based medication adherence intervention is expensive, the monthly cost of implementing and delivering the intervention is low. If the efficacy of similar interventions can be established, these results suggest that Internet could be an effective method for delivering medication adherence interventions to persons residing in areas with limited access to in-person adherence services.
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Nemes MIB, Helena ETDS, Caraciolo JMM, Basso CR. Assessing patient adherence to chronic diseases treatment: differentiating between epidemiological and clinical approaches. CAD SAUDE PUBLICA 2010; 25 Suppl 3:S392-400. [PMID: 20027387 DOI: 10.1590/s0102-311x2009001500005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Accepted: 05/18/2009] [Indexed: 12/20/2022] Open
Abstract
This review discusses the concepts and methods for assessing patient adherence to treatment, as applied to both epidemiological and clinical approaches within real health care practices. For the epidemiological approach, the assessment must be as accurate as possible. Self-reported questionnaires are the most feasible option in most circumstances, but most demonstrate low sensitivity combined with high specificity. We suggest that self-reported outcomes, where feasible, can increase the sensitivity for non-adherence of these questionnaires. In the clinical approach an accurate distinction between adherents and non-adherents is less useful. For the health provider, it is more important to be aware of the particular situation that each patient is currently experiencing with his/her treatment. Self-reported questionnaires applied in clinical settings can help the health provider to form an objective opinion. In any event, the patient-provider dialogue is still the best approach to assess patient adherence as well as to deliver good care.
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Affiliation(s)
| | | | | | - Cáritas Relva Basso
- Universidade de São Paulo, Brasil; Secretaria Estadual de Saúde de São Paulo, Brasil
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Duggan JM, Locher A, Fink B, Okonta C, Chakraborty J. Adherence to antiretroviral therapy: a survey of factors associated with medication usage. AIDS Care 2010; 21:1141-7. [PMID: 20024773 DOI: 10.1080/09540120902730039] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The use of highly active antiretroviral therapy (HAART) has decreased morbidity and mortality for people living with HIV/AIDS, but adherence to HAART is a critical factor in successful treatment. Adherence to medication is a complex and poorly understood behavior. A survey was undertaken to evaluate subjective correlates of adherence and non-adherence based on previously distilled themes from a qualitative study of adherence. A 60-question survey was completed by patients in the outpatient clinic setting regarding demographics, CD4 cell count, viral load, adherence, and screening questions about medication usage and attitudes toward HIV. Ninety-eight adherent and 34 non-adherent patients completed the survey. After logistic regression analysis, several questions appeared to be the main predictors of non-adherence: Have you ever thought of having HIV as a "punishment?" Do you feel that your medicines are hard to take? Do you believe the medicines for HIV that you take are working for you? These questions may be helpful in the development of a clinically useful screening tool to assess patients at risk for non-adherence.
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Affiliation(s)
- Joan M Duggan
- Department of Medicine, Ryan White Program at the University of Toledo, Toledo, OH, USA.
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Fumaz CR, Muñoz-Moreno JA, Moltó J, Ferrer MJ, López-Blázquez R, Negredo E, Paredes R, Gómez G, Clotet B. Sustained antiretroviral treatment adherence in survivors of the pre-HAART era: attitudes and beliefs. AIDS Care 2008; 20:796-805. [PMID: 18728987 DOI: 10.1080/09540120701694022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The objective of this study was to assess adherence of HIV-1-infected patients who started treatment in the pre-HAART era and to determine variables associated with better adherence, including relevant attitudes and beliefs. This is a cross-sectional study enrolling patients who had received antiretroviral therapy for >or=10 years. Adherence was evaluated through self-reporting and plasma drug concentrations. Treatment variables, attitudes and beliefs were collected during structured interviews. The results show that for 87 patients the median (interquartile range) time on therapy was 13 (10-19) years; 80 were on therapy at the time of analysis. Adherence was >or=95% in 54 patients (67.5%), 90-94% in 22 (27.5%) and <90% in 4 (5%). Drug concentrations were below the lower limit of detection in five patients. Younger age (p=0.014), female gender (p=0.005), current substance abuse (p=0.004) and hepatitis C virus co-infection (p<0.001) were related to lower adherence. Adherence did not differ in relation to different drug families or once- or twice-daily regimens. Patients with adherence <95% were more likely to have interrupted treatment without doctor's recommendation (p=0.009). Adherent patients exhibited a higher perception of risk of developing the illness and of benefits of therapy, higher self-efficacy and intention to adhere and were more influenced by events that motivate medication intake. To conclude, adherence was >90% in most patients on antiretroviral therapy for >or=10 years. Adherence was more related to beliefs about health and illness than to the characteristics of medication or level of knowledge about treatment. Care adherence interventions should include assessment of health beliefs.
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Affiliation(s)
- C R Fumaz
- Lluita contra la SIDA Foundation, Barcelona, Spain.
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Boyle BA, Jayaweera D, Witt MD, Grimm K, Maa JF, Seekins DW. Randomization to once-daily stavudine extended release/lamivudine/efavirenz versus a more frequent regimen improves adherence while maintaining viral suppression. HIV CLINICAL TRIALS 2008; 9:164-76. [PMID: 18547903 DOI: 10.1310/hct0903-164] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND In antiretroviral (ARV) therapy, pill burden, dosing frequency, and regimen complexity adversely affect adherence. We sought to evaluate the effect of regimen simplification on maintenance of virologic suppression and treatment adherence. METHOD In this 48-week, open-label, randomized study, 320 HIV-1-infected adult patients with a viral load of <50 copies/mL on a twice-daily or more frequent ARV regimen were either switched to a once-daily regimen of efavirenz, extended-release stavudine, and lamivudine (QD arm) or continued on existing therapy (BID+ arm). Medication Event Monitoring System (MEMS) caps, AIDS Clinical Trials Group (ACTG)-validated questionnaire, and pill counts were used to evaluate adherence. Treatment satisfaction and preference were also evaluated. RESULTS The QD arm was noninferior to the BID+ arm in the primary efficacy measure (proportion of patients who maintained virologic suppression at Week 48; QD arm, 80.0% vs. BID+ arm, 75.8%). Adherence and treatment satisfaction significantly favored the QD arm, in which 91.0% of patients preferred the simpler regimen. Overall, the majority of adverse events were mild to moderate in severity and resulted in a low rate of treatment discontinuations. CONCLUSIONS Simplifying twice-daily or more frequent ARV therapy to a once-daily efavirenz-containing regimen in virologically suppressed HIV-1-infected patients maintains virologic suppression while improving adherence and patient satisfaction.
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Affiliation(s)
- Brian A Boyle
- Weill Medical College of Cornell University, New York, New York, USA.
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Hacker MA, Kaida A, Hogg RS, Bastos FI. The first ten years: achievements and challenges of the Brazilian program of universal access to HIV/AIDS comprehensive management and care, 1996-2006. CAD SAUDE PUBLICA 2008; 23 Suppl 3:S345-59. [PMID: 17992341 DOI: 10.1590/s0102-311x2007001500003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2006] [Accepted: 04/16/2007] [Indexed: 12/18/2022] Open
Abstract
A review was carried out of papers published between 1996 and 2006, documenting the introduction of highly active anti-retroviral therapy (HAART) in Brazil. Papers indexed in the MEDLINE and SciELO databases were retrieved using different combinations of keywords related to the management and care of AIDS in the post-HAART era: opportunistic diseases and co-infections, adherence to therapy, survival in the pre- and post-HAART eras, adverse events and side-effects, emergence and possible transmission of resistant viral strains, metabolic and cardiovascular disorders, and issues related to access to care and equity. The review documents the dramatic changes in HIV/AIDS disease progression in the post-HAART era, including an increase in survival and quality of life and a pronounced decrease in the episodes of opportunistic diseases. Notwithstanding such major achievements, new challenges have emerged, including slow evolving co-infections (such as hepatitis C, metabolic and cardiovascular disorders), the emergence of viral resistance, with consequences at the individual level (virological failure) and the community level (primary/secondary resistance at the population level), and impacts on the cost of new therapeutic regimens.
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Affiliation(s)
| | - Angela Kaida
- University of British Columbia, Canada; BC Centre for Excellence in HIV/AIDS, Canada
| | - Robert S. Hogg
- BC Centre for Excellence in HIV/AIDS, Canada; Simon Fraser University, Canada
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Lucas GM, Mullen BA, McCaul ME, Weidle PJ, Hader S, Moore RD. Adherence, drug use, and treatment failure in a methadone-clinic-based program of directly administered antiretroviral therapy. AIDS Patient Care STDS 2007; 21:564-74. [PMID: 17711381 DOI: 10.1089/apc.2006.0192] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Supervised dosing is a cornerstone of tuberculosis treatment. HIV treatment strategies that use directly administered antiretroviral therapy (DAART) are increasingly being assessed. In a prospective single-arm clinical trial, we enrolled methadone-maintained, HIV-infected participants to receive supervised doses of antiretroviral therapy (ART) on days when they received methadone. Other ART doses were self-administered. In this analysis we examined factors associated with retention to DAART, adherence to supervised doses, and virologic failure. Factors associated with retention to DAART were assessed with the Kaplan-Meier method and Cox proportional hazards models. Factors associated with nonadherence with supervised dosing and with virologic failure were assessed by logistic regression and techniques for longitudinal data analysis. A total of 16,453 supervised doses were administered to 88 participants over a median follow-up of 9.4 months. The median participant adherence with supervised dosing was 83%. Active drug use, determined by urine drug screens, was associated twofold increased risks of both intervention dropout and nonadherence with supervised doses. Adherence with supervised doses was strongly associated with virologic failure. Because DAART was administered only on methadone dosing days, fewer than half of the total ART doses were scheduled to be supervised in most participants. The percent of doses that was scheduled to be supervised was not associated with either adherence or with virologic failure. Given that a relatively small proportion of the total ART doses were supervised in many patients, future studies should assess how DAART affects adherence with nonsupervised doses and retention to ART.
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Affiliation(s)
- Gregory M Lucas
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA.
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Wu AW, Snyder CF, Huang IC, Skolasky R, McGruder HF, Celano SA, Selnes OA, Andrade AS. A randomized trial of the impact of a programmable medication reminder device on quality of life in patients with AIDS. AIDS Patient Care STDS 2006; 20:773-81. [PMID: 17134351 DOI: 10.1089/apc.2006.20.773] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This 6-month randomized controlled trial evaluated the impact on quality of life (QOL) of a medication reminder device for patients with HIV. Patients were eligible if they had taken three or fewer highly active antiretroviral therapy (HAART) regimens or were treatment naïve. The intervention group received the Disease Management Assistance System (DMAS), a prompting device that verbally reminds patients at medication times and electronically records doses, and a monthly 30 minute adherence educational session. Controls received education only. QOL was measured at baseline and 6 months using the Centers for Epidemiologic Studies Depression Scale (CES-D), Instrumental Activities of Daily Living (IADLs), and the Medical Outcomes Study HIV Health Survey (MOS-HIV). At baseline, 62 patients completed surveys (31 control, 31 DMAS); at month 6, 48 patients completed surveys (23 control, 25 DMAS). At month 6, controls had improved QOL scores for CES-D, IADLs, physical health, general health, pain, QOL, and role functioning, while participants in the DMAS arm had some deterioration in QOL scores. These differences persisted after controlling for demographics, baseline CD4, and adherence. DMAS was associated with improved adherence but decreased QOL.
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Affiliation(s)
- Albert W Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Cooperman NA, Arnsten JH. Motivational interviewing for improving adherence to antiretroviral medications. Curr HIV/AIDS Rep 2006; 2:159-64. [PMID: 16343372 DOI: 10.1007/s11904-005-0010-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Many interventions have been developed to address barriers to antiretroviral medication adherence, but few have focused on motivation, a fundamental component of behavior change. Research on other health behavior changes and a few pilot studies investigating motivational interviewing (MI) for adherence to antiretroviral medication suggests that MI may be highly beneficial by helping to motivate patients with HIV to adhere to their medications. Existing research, although limited, suggests that MI combined with other interventions is feasible and efficacious for improving adherence to antiretroviral medications. With continued development and refinement of antiretroviral adherence interventions that incorporate MI, more persons with HIV infection can be expected to choose to make the difficult changes necessary for them to benefit from antiretroviral therapy.
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Affiliation(s)
- Nina A Cooperman
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
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