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Ortego C, Huedo-Medina TB, Santos P, Rodríguez E, Sevilla L, Warren M, Llorca J. Sex differences in adherence to highly active antiretroviral therapy: a meta-analysis. AIDS Care 2012; 24:1519-34. [PMID: 22533692 DOI: 10.1080/09540121.2012.672722] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Observational studies have found that women tend to have lower adherence to highly active antiretroviral therapy (HAART) than men do, though no meta-analysis has yet investigated this trend. The aims of the current meta-analysis are to determine if and to what degree the percentage of men versus women maintaining ≥90% adherence to prescribed HAART differs, and if the external variables moderating adherence differs by gender. Eight electronic databases were searched to locate all relevant studies available by May 2011. Fifty-six observational studies were eligible for inclusion in the meta-analysis. A random effect model was assumed for the global percentage estimation and to explain the heterogeneity. Across these studies, the difference between men and women in the proportion of individuals with ≥90% adherence to HAART was marginally significant (p<0.1; 67% and 62%, respectively). A greater proportion of men maintaining ≥90% adherence to HAART was more likely in studies with higher proportions of men who have sex with men (MSM), lower proportions of male alcohol users or lower proportions of men in a methadone program. In women, higher rates of adherence were found in studies conducted in Africa, Asia, and South America, when the sample included more widows or when the sample had a lower basal CD4 count. That both the percentage of adherent individuals and the variables associated with such adherence differ between men and women are suggestive of the need for improving gender-tailored interventions for adherence to HAART.
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Affiliation(s)
- C Ortego
- Nursing Department, University of Cantabria, Spain.
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Ortego C, Huedo-Medina TB, Llorca J, Sevilla L, Santos P, Rodríguez E, Warren MR, Vejo J. Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS Behav 2011; 15:1381-96. [PMID: 21468660 DOI: 10.1007/s10461-011-9942-x] [Citation(s) in RCA: 236] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This meta-analysis synthesizes eighty-four observational studies, conducted across twenty countries, to determine the mean proportion of people who reported ≥90% adherence to prescribed highly active antiretroviral therapy (HAART) and to identify the factors associated with high levels of adherence. Eight electronic databases were searched to locate all relevant studies available by January 2010, which were then coded for sample characteristics and adherence levels. The average rate of reporting ≥90% adherent HAART adherence is 62%. However, this proportion varies greatly across studies. In particular, a greater proportion of individuals maintaining ≥90% adherence to HAART is more likely in studies with higher proportions of men who have sex with men (MSM) and lower proportions of injection drug users (IDU), with participants in an earlier stage of infection, and in studies conducted in countries characterized by lower Human Development Index (HDI) scores.
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Affiliation(s)
- Carmen Ortego
- Nursing Department, University of Cantabria, Santander, Spain.
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Ortego C, Huedo-Medina TB, Vejo J, Llorca FJ. Adherence to highly active antiretroviral therapy in Spain. A meta-analysis. GACETA SANITARIA 2011; 25:282-9. [PMID: 21546132 DOI: 10.1016/j.gaceta.2010.10.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 07/21/2010] [Accepted: 10/05/2010] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To estimate the percentage of adherence to highly-active antiretroviral therapy (HAART) in Spanish observational studies and to identify the variables associated with adherence. METHODS Seven electronic databases were used to locate the studies. Six inclusion criteria were established. Two coders codified the variables independently. Intercoder reliability was calculated. Publication bias was analyzed through the Begg, Egger and Trim and Fill tests. Homogeneity was evaluated using the Q test and the l² index. A random effects model was assumed to estimate both the overall percentage of adherence and to explain heterogeneity. RESULTS This meta-analysis included 23 observational studies, yielding a total of 34 adherence estimates. The sample was composed of 9,931 HIV-positive individuals (72% men) older than 18 years under treatment with HAART. The percentage of patients adhering to an intake of >90% of the prescribed antiretroviral drugs was 55%. Wide heterogeneity was detected (I² =91.20; 95%CI: 88.75-93.13). Adherence was mainly measured using a single strategy (47.8%), the most widely used being self-report (48.7%). In the univariate analysis, the following factors were significant: infection stages A (β=0.68, p <0.001) and B (β=-0.56, p <0.01), viral loads >200 copies/ml (β=-0.41, p <0.05) and <200 (β=0.39, p <0.05), and university education (β=-0.66, p<0.05). CONCLUSIONS The overall percentage of adherence was 55%, although this value may be an overestimate. Adherence was associated with infection stage A and with a viral load of <200 copies/ml.
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Affiliation(s)
- Carmen Ortego
- Departamento de Enfermería, University of Cantabria, Spain.
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4
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Applebaum AJ, Reilly LC, Gonzalez JS, Richardson MA, Leveroni CL, Safren SA. The impact of neuropsychological functioning on adherence to HAART in HIV-infected substance abuse patients. AIDS Patient Care STDS 2009; 23:455-62. [PMID: 19519229 DOI: 10.1089/apc.2008.0181] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
This study assessed the frequency of neuropsychological impairment and its relationship to adherence in a sample of HIV-infected injection drug users (IDUs) in treatment. One hundred eight participants recruited between September 2006 and October 2008 completed psychodiagnostic and neuropsychological assessments and monitored HAART adherence over a 2-week period via the use of Medication Event Monitoring System (MEMS) electronic pill caps and self-report. Assessment of concurrent functioning included clinician-rated scales of depression and substance use severity, and a battery of neuropsychological tests. Findings from individual neuropsychological tests were converted to Z scores relative to standard norms and averaged to form a composite score (NPZ). NPZ was generally poor (mean = -1.505, standard deviation = 1.120), with 76.9% of the sample being classified as highly impaired. Self-reported adherence was significantly higher than MEMS cap adherence. In contrast with previous studies, overall neuropsychological functioning was not a significant predictor of electronically monitored or self-reported adherence. However, examiner-rated current global severity of substance use and delayed word list recall emerged as significant predictors of self-reported adherence. Additionally, estimated premorbid verbal intelligence emerged as a significant predictor of the discrepancy between electronically monitored and self-reported adherence. Given the extent of neuropsychological impairment in this sample, future studies should examine the degree to which the impact of neuropsychological impairment may moderate interventions for this population, and the extent to which skills to cope with neuropsychological problems may boost the potential efficacy of such interventions.
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Affiliation(s)
- Allison J. Applebaum
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Department of Psychology, Boston University, Boston, Massachusetts
| | - Laura C. Reilly
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey S. Gonzalez
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Yeshiva University, Bronx, New York
| | - Mark A. Richardson
- Department of Psychology, Boston University, Boston, Massachusetts
- Division of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Catherine L. Leveroni
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Steven A. Safren
- Behavioral Medicine Services, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
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5
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Factores relacionados con la adherencia en pacientes infectados por el virus de la inmunodeficiencia humana. FARMACIA HOSPITALARIA 2009. [DOI: 10.1016/s1130-6343(09)70729-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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6
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Soroudi N, Perez GK, Gonzalez JS, Greer JA, Pollack MH, Otto MW, Safren SA. CBT for Medication Adherence and Depression (CBT-AD) in HIV-Infected Patients Receiving Methadone Maintenance Therapy. COGNITIVE AND BEHAVIORAL PRACTICE 2008. [DOI: 10.1016/j.cbpra.2006.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Berg CJ, Michelson SE, Safren SA. Behavioral aspects of HIV care: adherence, depression, substance use, and HIV-transmission behaviors. Infect Dis Clin North Am 2007; 21:181-200, x. [PMID: 17502235 DOI: 10.1016/j.idc.2007.01.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A variety of psychosocial stressors are involved in living with HIV, maintaining a regimen of highly active antiretroviral therapy, and negotiating necessary self-care behaviors. Because health care providers are in regular contact with HIV-infected individuals in care, these contacts allow for the opportunity to assess and intervene on important variables related to quality of life and HIV outcomes. This article reviews information about four important behavioral aspects of HIV care: treatment adherence, depression, high-risk sex, and substance abuse. Efforts by health care providers to address these factors may result in better treatment outcomes, enhanced quality of life among HIV patients, and decreased HIV transmission.
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Affiliation(s)
- Carla J Berg
- Massachusetts General Hospital/Harvard Medical School, Boston, MA 02114, USA
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8
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Lewis MP, Colbert A, Erlen J, Meyers M. A qualitative study of persons who are 100% adherent to antiretroviral therapy. AIDS Care 2007; 18:140-8. [PMID: 16338772 DOI: 10.1080/09540120500161835] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This qualitative study examined the medication-taking behaviors and attitudes of participants determined to be 100% adherers to antiretroviral therapy from a NIH-funded study testing a 12-week telephone adherence intervention. Using open-ended questions, interviewers collected data on a sample of 13 informants, whose medication adherence to a randomly selected antiretroviral medication was 100%, based on a 30-day data collection using electronic event monitoring (EEM). The analysis revealed 'successful medication management' as the core category or main theme. The participants achieved success with medication adherence through managing specific areas (regimen, self and environment). By adopting realistic expectations and pragmatic attitudes, adherence is fostered when medication taking is a priority, when patients believe in the efficacy of their medications and when there is a strong patient/provider relationship. Future research is needed to develop tailored interventions using strategies identified by this population. Further in-depth examination of medication-taking behaviors in 100% adherers may be useful in developing individualized programs to maximize adherence to antiretroviral therapy in the clinical setting.
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Affiliation(s)
- M P Lewis
- Department of Nursing and Allied Health, State University of New York at Delhi, Delhi, NY 13753, USA.
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Gratacòs L, Tuset M, Codina C, Miró JM, Mallolas J, Miserachs N, Martín-Conde MT, del Cacho E, Lazzari ED, Ribas J, Gatell JM. [Antiretroviral therapy of HIV infection: duration and reasons for changing the first therapeutic regimen in 518 patients]. Med Clin (Barc) 2006; 126:241-5. [PMID: 16510064 DOI: 10.1157/13085280] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Different combinations of antiretroviral drugs are used as initial HIV therapy but comparative studies between them are not frequent. The objectives of this study are to determine the median duration of different therapy combinations in naive patients between 1998-2000 and the main reasons for changing or stopping this first antiretroviral therapy (ARVT). PATIENTS AND METHOD This study included a total of 518 naive patients who began antiretroviral therapy patients from 1998-2000. Using a Kaplan-Meier analysis the median duration of different combinations was determined. In addition, the main reasons for changing or stopping this first treatment were analysed. RESULTS First ARVT median duration was 427 days (IQR: 114-890). 47% of patients stopped their first therapy due to adverse effects, 6% voluntarily withdrew from it, in 9% of patients the therapy was not effective and 15% of them were lost of follow up. Only 9% of them continued with the same ARVT at the end of the study but if we add 7% of treatment simplifications we can consider 16% of first ARVT successful. CONCLUSIONS A median duration of 427 days, similar to other studies, is shorter than we would prefer for HIV, a condition that requires continuous treatment. On the other hand, the study corroborates that secondary effects are the principal problem associated with ARVT.
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Affiliation(s)
- Laura Gratacòs
- Servicio de Farmacia, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain.
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Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med 2006. [PMID: 16314608 DOI: 10.1097/01.psy.0000188569] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Most previous longitudinal studies demonstrating relationships between psychosocial variables and human immunodeficiency virus (HIV) disease progression utilized samples of gay men accrued before the era of highly active antiretroviral treatment (HAART), without including viral load (VL) as an indicator of disease progression or assessing the impact of medication adherence. This study sought to determine whether psychosocial variables would predict both CD4 and VL changes in a diverse sample assessed entirely during the era of HAART and accounting for adherence effects. METHODS This longitudinal study assessed a multiethnic HIV+ sample (n = 177) of men and women in the midrange of illness (CD4 number between 150 and 500; no previous acquired immunodeficiency syndrome [AIDS]-defining symptom) every 6 months for 2 years. Hierarchical linear modeling was used to model change in CD4 and VL controlling for sociodemographics (age, gender, ethnicity, education) and medical variables (baseline CD4/VL, antiretroviral medications at each time point, adherence). RESULTS Baseline depression, hopelessness, and education predicted the slope of CD4 and VL. Avoidant coping and life event stress predicted VL change. Cumulative variables produced stronger relationships (depression, avoidant coping, and hopelessness with CD4/VL slope and life events stress with VL slope). High cumulative depression and avoidant coping were associated with approximately twice the rate of decline in CD4 as low scorers and greater relative increases in VL. Social support was not significantly related to CD4 or VL slope. CONCLUSIONS Psychosocial factors contribute significantly to the variance in HIV disease progression (assessed through CD4 number and VL) in a diverse sample, accounting for adherence and do so in the era of HAART.
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Ruiz Pérez I, Soto Blanco JM, Olry de Labry Lima A, Antón Basante JJ, Castro Recio JM, Girela López E. [Mental morbidity and social support in prisoners in treatment with antiretrovirals]. Rev Clin Esp 2005; 205:212-7. [PMID: 15970151 DOI: 10.1157/13075570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To define the incidence of depressive disorders and anxiety disorders in prisoners of three prisons of CCAA in treatment with antiretrovirals, and moreover the associated variables and the intensity of social support within the prison. METHODS Through a cross-sectional design 281 prisoners were studied. RESULTS 42% showed mental morbidity and 53.4% lacked social support. To be imprisoned in the Granada prison, to be a woman, poor health state, to describe difficulties for compliance with antiretrovirals drug, a history greater than 13 years for drugs consumption, and usual residence with the couple of family, all were factors associated with mental morbidity. Factors associated with social support non-existence were history of more than one imprisonment, lack of familiarity with the medical equipment, to be more than 35 years old, and to suffer mental morbidity.
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Affiliation(s)
- I Ruiz Pérez
- Area de Salud Pública, Escuela de Salud Pública, Granada.
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12
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Knobel H, Escobar I, Polo R, Ortega L, Martín-Conde MT, Casado JL, Codina C, Fernández J, Galindo MJ, Ibarra O, Llinas M, Miralles C, Riera M, Fumaz CR, Segador A, Segura F, Chamorro L. Recomendaciones GESIDA/SEFH/PNS para mejorar la adherencia al tratamiento antirretroviral en el año 2004. Enferm Infecc Microbiol Clin 2005; 23:221-31. [PMID: 15826548 DOI: 10.1157/13073149] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Since the early days of antiretroviral therapy, adherence has emerged as the milestone of success; in fact, it is the most potent predictor of effectiveness. The main factors related to adherence include the complexity of the therapeutic regimen, adverse effects, psychological problems, alcoholism and active addiction to drugs, lack of social and family support and the patient's beliefs and attitudes about the treatment. Adherence monitoring should be part of the HIV patient's regular care, and should be done with feasible, easily applied methods adapted to the different clinical settings. The minimally acceptable measures should include use of a validated questionnaire, together with data from the Pharmacy Department's drug dispensation registry. All patients that begin HAART or undergo a change of treatment should participate in a treatment education program imparted by health professionals with knowledge and experience in the management of patients with HIV infection. The health team (doctors, pharmacists and nursing professionals) should offer maximum availability to solve the doubts and problems that may occur during treatment. When sub-optimal adherence is detected, intervention strategies based on psychological therapy, educational efforts and personal advice should be attempted, in order to adapt the treatment scheme to the patient's habits and provide solutions to the problem of non-compliance. In certain situations, co-morbid conditions will also require attention. Treatment adherence, being a multidimensional problem, needs a multidisciplinary team approach. The choice of therapy, only one aspect of the multidimensional problem of adherence, must be a careful and individualized decision; however, simpler regimens with regard to the number of pills and daily dose are desirable.
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Affiliation(s)
- Hernando Knobel
- Servicio Medicina Interna, Hospital del Mar, Barcelona, Spain.
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13
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Ironson G, O'Cleirigh C, Fletcher MA, Laurenceau JP, Balbin E, Klimas N, Schneiderman N, Solomon G. Psychosocial factors predict CD4 and viral load change in men and women with human immunodeficiency virus in the era of highly active antiretroviral treatment. Psychosom Med 2005; 67:1013-21. [PMID: 16314608 PMCID: PMC2614887 DOI: 10.1097/01.psy.0000188569.58998.c8] [Citation(s) in RCA: 260] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Most previous longitudinal studies demonstrating relationships between psychosocial variables and human immunodeficiency virus (HIV) disease progression utilized samples of gay men accrued before the era of highly active antiretroviral treatment (HAART), without including viral load (VL) as an indicator of disease progression or assessing the impact of medication adherence. This study sought to determine whether psychosocial variables would predict both CD4 and VL changes in a diverse sample assessed entirely during the era of HAART and accounting for adherence effects. METHODS This longitudinal study assessed a multiethnic HIV+ sample (n = 177) of men and women in the midrange of illness (CD4 number between 150 and 500; no previous acquired immunodeficiency syndrome [AIDS]-defining symptom) every 6 months for 2 years. Hierarchical linear modeling was used to model change in CD4 and VL controlling for sociodemographics (age, gender, ethnicity, education) and medical variables (baseline CD4/VL, antiretroviral medications at each time point, adherence). RESULTS Baseline depression, hopelessness, and education predicted the slope of CD4 and VL. Avoidant coping and life event stress predicted VL change. Cumulative variables produced stronger relationships (depression, avoidant coping, and hopelessness with CD4/VL slope and life events stress with VL slope). High cumulative depression and avoidant coping were associated with approximately twice the rate of decline in CD4 as low scorers and greater relative increases in VL. Social support was not significantly related to CD4 or VL slope. CONCLUSIONS Psychosocial factors contribute significantly to the variance in HIV disease progression (assessed through CD4 number and VL) in a diverse sample, accounting for adherence and do so in the era of HAART.
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Affiliation(s)
- Gail Ironson
- Department of Psychology and Behavioral Medicine, University of Miami, Coral Gables, Florida 33124-2070, USA.
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Ortega L, Cuevas MJ, Pérez-Simón R, Villares C, Alcoba M, Martín V. Factores predictores de carga viral detectable en pacientes en tratamiento antirretroviral de gran actividad. Med Clin (Barc) 2004; 123:45-9. [PMID: 15225482 DOI: 10.1016/s0025-7753(04)74407-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND AND OBJECTIVE Knowledge of the variables predicting detectable viral load in patients with highly active antiretroviral treatment. PATIENTS AND METHOD Observational and cross-sectional study in patients with antiretroviral treatment receiving two nucleoside reverse transcriptase inhibitors and one protease inhibitor. Several sociodemographic and clinic variables were registered. Two models were designed in order to assess the adherence: I. combining self-report and pharmacy criteria, and II. including drug plasma levels in adherent patients with the two former criteria and detectable viral load. Logistic regression analysis with variables found to be associated with detectable viral load in the univariate analysis, diagnostic algorithm and ROC statistics were performed in order to select the best model to predict detectable viral load. RESULTS Among of 136 patients studied, 39 (28.7%) had detectable viral load. Patients less than 35 years old (OR = 2.68), intravenous drug users or heterosexual contacts as the way of HIV infection (OR = 6.42), patients not fully convinced of the capacity of mutation of the HIV by poor adherence (OR = 3.25) and patients considered non-adherent according to the drug plasma levels criteria (OR = 6.91) had more frequently detectable viral load. The best model to predict detectable viral load would include patients considered non-adherent according to the two models used, and moreover, patients where another of the factors of risk were detected; the prevalence of detectable viral load in these was of 10% versus 43%. CONCLUSION Adherence to HAART is a key factor to predict detectable viral load, specially in young patients, infected by intravenous drug use or heterosexual contacts, and patients not convinced of the importance of the adherence.
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Affiliation(s)
- Luis Ortega
- Servicio de Farmacia, Hospital de León, León, Spain
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15
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Muga R, Guardiola H, Rey-Joly C. [Evaluation of drug addicts with associated pathology. Clinical and therapeutic aspects of the integral attention]. Med Clin (Barc) 2004; 122:624-35. [PMID: 15142512 DOI: 10.1016/s0025-7753(04)74332-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We review the evaluation and treatment of patients with drug addictions complicated by other acute or chronic diseases from the perspective of the hospital setting. The spectrum of drug addiction's complications is broad and in many instances it is predetermined by the abuse substance and its administration route. Some complications of intravenous drug addiction have dramatically decreased in the last few years as a result of a better knowledge of hygienic customs and after the implementation of some health interventions such as the provision of sterile injectable devices. Two highly prevalent infections --HIV/AIDS and hepatitis C-- remain from the period in which most HIV infections owed to the intravenous use of heroin. Of note, these two infections largely account for the survival and quality of life of those who quit their addiction. On the other hand, it is still common the hospitalization of patients with both alcohol dependence and intercurrent diseases in whom their drug addiction may pass unnoticed. Other common situations include the treatment of acute patients with cocaine addiction and psychiatric comorbidity, patients under methadone therapy and, in general, all those cases in which, in emergency, ordinary hospital wards and specialized units, a wide differential diagnosis is raised when there is a coexistence of signs and symptoms common to an addiction, infection and/or intoxication. An integral vision of drug addiction and its complications, as well as the clinical evaluation of all health problems, is fundamental for the prognosis and treatment of these patients.
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Affiliation(s)
- Roberto Muga
- Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, Badalona, España.
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16
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Abstract
BACKGROUND Non-adherence to human immunodeficiency virus (HIV) medications often results in irreparable drug resistance and poor outcomes. Hence, care providers generally think that treatment of HIV disease should be delayed until a person is 'ready' to adhere. However, little research has focused on understanding the process that results in readiness for successful adherence. AIM The aim of this phenomenological study was to describe and understand the experience and decision-making processes of people who became adherent to their HIV medication regimens after previously failing treatment because of non-adherence. METHOD A Husserlian phenomenological approach was taken, and in-depth interviews were analysed using Giorgi's method of phenomenological description and analysis. FINDINGS Thirteen HIV-positive men and women who had previously failed two or more treatment regimens because of non-adherence were purposefully selected from two infectious diseases clinics in the Midwest region of the United States. They had achieved and sustained adherence to their HIV medications for 1 year or longer without formal intervention. All participants experienced a 'trigger' event preceding the process that led to the ability to incorporate lifestyle and health behaviour changes necessary for successful adherence. Factors associated with the process leading to adherence were: changing attitudes towards HIV medication, finding the right health care provider, creating the right support system, getting control of life and having goals. CONCLUSIONS This study demonstrated that HIV-positive individuals who had been non-adherent and had been viewed as 'difficult to treat' nonetheless successfully adhered to treatment once they became 'ready'. Findings from this study implicate that readiness may be a necessary component for successful adherence, particularly in HIV-positive individuals who have previously failed treatment. Understanding the relationship between the phenomenon of readiness and subsequent HIV treatment adherence has implications for clinical decision-making and for development of interventions that enhance adherence and prevent HIV drug resistance.
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Affiliation(s)
- Maithe Enriquez
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.
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Rosario Pérez-Simón M, José Cuevas M, Ortega L, Antonio Carro J, Luis Mostaza J, Martín V. Valoración de la adhesión al tratamiento antirretroviral: papel de la determinación de la concentración plasmática de los fármacos no análogos de nucleósidos. Med Clin (Barc) 2003. [DOI: 10.1016/s0025-7753(03)73815-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Pulido Ortega F. Estudio epidemiológico retrospectivo sobre la duración del tratamiento de la infección por el virus de la inmunodeficiencia humana en España. Med Clin (Barc) 2002. [DOI: 10.1016/s0025-7753(02)73556-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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