Skip to main content

Advertisement

SpringerLink
Log in

Correlates of Combination Antiretroviral Adherence Among Recently Diagnosed Older HIV-Infected Adults Between 50 and 64 years

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Optimal adherence to combination antiretroviral therapy is essential to the health of older people living with HIV (PLWH), however, the literature on adherence and aging is limited. Using Medicaid data from 29 states (N = 5177), we explored correlates of optimal adherence among older PLWH. The prevalence of optimal adherence was low (32 %) in this study. Males were more adherent than females (APR = 1.11, 95 % CI 1.02–1.21, P = 0.0127); persons with three or more co-morbidities (APR = 0.67, 95 % CI 0.60–0.74, P < 0.001), two co-morbidities (APR = 0.86, 95 % CI 0.75–0.98, P = 0.0319) and one co-morbidity (APR = 0.82, 95 % CI 0.73–0.92, P = 0.0008) were less adherent than those without any co-morbidity; and residents of rural areas (APR = 0.90, 95 % CI 0.63–0.98, P = 0.0385) and small metropolitan areas (APR = 0.82, 95 % CI 0.72–0.94, P = 0.0032) were less adherent than residents of large metropolitan areas. There were no racial differences in optimal adherence. Targeted interventions that provide adherence support, case management, and peer navigation services may be of benefit in achieving optimal adherence in this population.

Resumen

Alcanzar una óptima adherencia a la terapia antiretroviral es esencial para mantener la salud de adultos mayores viviendo con VIH (PVVIH). Sin embargo, hay una escasez de estudios enfocados en adherencia en adultos mayores. Usando datos de Medicaid provenientes de 29 estados, exploramos factores que afectan la adherencia en PVVIH que son adultos mayores. La prevalencia de adherencia óptima fue baja (32 %) entre los 5177 participantes. Los hombres fueron más adherentes que las mujeres [razón de prevalencia ajustada (RPA) = 1.11, 95 % intervalo de confianza (IC) = 1.02–1.21, P = 0.0127]; mientras que personas con tres o más comorbilidades (RPA = 0.67, 95 % IC 0.60–0.74, P < 0.001), dos comorbilidades (RPA = 0.86, 95 % IC 0.75–0.98, P = 0.0319), y una comorbilidad (RPA = 0.82, 95 % IC 0.73–0.92, P = 0.0008) fueron menos adherentes que aquellos sin comorbilidades. Residentes de áreas rurales (RPA = 0.90, 95 % IC 0.63–0.98, P = 0.0385) y áreas metropolitanas pequeñas (RPA = 0.82, 95 % IC 0.72–0.94, P = 0.0032) fueron menos adherentes que los residentes de grandes áreas metropolitanas. No hubo diferencias raciales en adherencia óptima. Intervenciones enfocadas a proveer apoyo de adherencia, coordinación de servicios y navegación por pares son críticas para alcanzar una adherencia óptima en esta población.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Brooks JT, Buchacz K, Gebo KA, Mermin J. HIV infection and older Americans: the public health perspective. Am J Public Health. 2012;102(8):1516–26.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Centers for Disease Control and Prevention. HIV surveillance report. 2014. http://www.cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report-us.pdf. Accessed 2 Feb 2016.

  3. Linley L, Prejean J, An Q, Chen M, Hall IH. Racial/ethnic disparities in HIV diagnoses among persons aged 50 years and older in 37 US States, 2005–2008. Am J Public Health. 2012;102(8):1527–34.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Navarro G, Nogueras MM, Segura F, et al. HIV-1 infected patients older than 50 years. PISCIS cohort study. J Infect. 2008;57(1):64–71.

    Article  CAS  PubMed  Google Scholar 

  5. Perez JL, Moore RD. Greater effect of highly active antiretroviral therapy on survival in people aged ≥50 years compared with younger people in an urban observational cohort. Clin Infect Dis. 2003;36(2):212–8.

    Article  PubMed  Google Scholar 

  6. Grabar S, Weiss L, Costagliola D. HIV infection in older patients in the HAART era. J Antimicrob Chemo. 2006;57(1):4–7.

    Article  CAS  Google Scholar 

  7. Abara WE, Smith L, Zhang S, Fairchild AJ, Heiman HJ, Rust G. The influence of race and comorbidity on the timely initiation of antiretroviral therapy among older persons living with HIV/AIDS. Am J Public Health. 2014;104(11):e135–41.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Davis DH, Smith R, Brown A, Rice B, Yin Z, Delpech V. Early diagnosis and treatment of HIV infection: magnitude of benefit on short-term mortality is greatest in older adults. Age Ageing. 2013;42(4):520–6.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Schick V, Herbenick D, Reece M, et al. Sexual behaviors, condom use, and sexual health of Americans over 50: implications for sexual health promotion for older adults. J Sexual Med. 2010;7(s5):315–29.

    Article  Google Scholar 

  10. Lindau ST, Schumm LP, Laumann EO, Levinson W, O’Muircheartaigh CA, Waite LJ. A study of sexuality and health among older adults in the United States. New Eng J Med. 2007;357(8):762–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Emlet CA. “You’re awfully old to have this disease”: experiences of stigma and ageism in adults 50 years and older living with HIV/AIDS. Gerontologist. 2007;46(6):781–90.

    Article  Google Scholar 

  12. Emlet CA. A comparison of HIV stigma and disclosure patterns between older and younger adults living with HIV/AIDS. AIDS Patient Care STDS. 2006;20(5):350–8.

    Article  PubMed  Google Scholar 

  13. Skiest DJ, Rubinstien E, Carley N, Gioiella L, Lyons R. The importance of comorbidity in HIV-infected patients over 55: a retrospective case-control study. Am J Med. 1996;101(6):605–11.

    Article  CAS  PubMed  Google Scholar 

  14. Shah SS, McGowan JP, Smith C, Blum S, Klein RS. Comorbid conditions, treatment, and health maintenance in older persons with human immunodeficiency virus infection in New York City. Clin Infect Dis. 2002;35(10):1238–43.

    Article  PubMed  Google Scholar 

  15. Orlando G, Meraviglia P, Cordier L, et al. Antiretroviral treatment and age-related comorbidities in a cohort of older HIV-infected patients. HIV Med. 2006;7(8):549–57.

    Article  CAS  PubMed  Google Scholar 

  16. Johnson CJ, Heckman TG, Hansen NB, Kochman A, Sikkema KJ. Adherence to antiretroviral medication in older adults living with HIV/AIDS: a comparison of alternative models. AIDS Care. 2009;21(5):541–51.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Cohen MS, Chen YQ, McCauley M, et al. HPTN 052 Study Team. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493–505.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Granich RM, Gilks CF, Dye C, De Cock KM, Williams BG. Universal voluntary HIV testing with immediate antiretroviral therapy as a strategy for elimination of HIV transmission: a mathematical model. Lancet. 2009;373(9657):48–57.

    Article  PubMed  Google Scholar 

  19. Skarbinski J, Rosenberg E, Paz-Bailey G, et al. Human immunodeficiency virus transmission at each step of the care continuum in the United States. JAMA Intern Med. 2015;175(4):588–96.

    Article  PubMed  Google Scholar 

  20. Kong MC, Nahata MC, Lacombe VA, Seiber EE, Balkrishnan R. Association between race, depression, and antiretroviral therapy adherence in a low-income population with HIV infection. J Gen Intern Med. 2012;27(9):1159–64.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Cohen CJ, Meyers JL, Davis KL. Association between daily antiretroviral pill burden and treatment adherence, hospitalization risk, and other healthcare utilization and costs in a US Medicaid population with HIV. BMJ Open. 2013;3(8):e003028.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Sax PE, Meyers JL, Mugavero M, Davis KL. Adherence to antiretroviral treatment and correlation with risk of hospitalization among commercially insured HIV patients in the United States. PLoS One. 2012;7(2):e31591.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Bottonari KA, Tripathi SP, Fortney JC, et al. Correlates of antiretroviral and antidepressant adherence among depressed HIV-infected patients. AIDS Patient Care STDs. 2012;26(5):265–73.

    Article  PubMed  Google Scholar 

  24. Kyser M, Buchacz K, Bush TJ, et al. Factors associated with non-adherence to antiretroviral therapy in the SUN study. AIDS Care. 2011;23(5):601–11.

    Article  PubMed  Google Scholar 

  25. Reynolds NR, Testa MA, Marc LG, et al. Factors influencing medication adherence beliefs and self-efficacy in persons naive to antiretroviral therapy: a multicenter, cross-sectional study. AIDS Behav. 2004;8(2):141–50.

    Article  PubMed  Google Scholar 

  26. Yun LW, Maravi M, Kobayashi JS, Barton PL, Davidson AJ. Antidepressant treatment improves adherence to antiretroviral therapy among depressed HIV-infected patients. J Acquir Immune Defic Syndr. 2005;38(4):432–8.

    Article  CAS  PubMed  Google Scholar 

  27. Hinkin CH, Hardy DJ, Mason KI, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS. 2004;18(S1):S19–25.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Parsons JT, Starks TJ, Millar BM, Boonrai K, Marcotte D. Patterns of substance use among HIV-positive adults over 50: implications for treatment and medication adherence. Drug Alc Depend. 2014;2014(139):33–40.

    Article  Google Scholar 

  29. Barclay TR, Hinkin CH, Castellon SA, et al. Age-associated predictors of medication adherence in HIV-positive adults: health beliefs, self-efficacy, and neurocognitive status. Health Psychol. 2007;26(1):40.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Brañas F, Berenguer J, Sánchez-Conde M, et al. The eldest of older adults living with HIV: response and adherence to highly active antiretroviral therapy. Am J Med. 2008;21(9):820–4.

    Article  Google Scholar 

  31. Bianco JA, Heckman TG, Sutton M, Watakakosol R, Lovejoy T. Predicting adherence to antiretroviral therapy in HIV-infected older adults: the moderating role of gender. AIDS Behav. 2011;15(7):1437–46.

    Article  PubMed  Google Scholar 

  32. Simone MJ, Appelbaum J. HIV in older adults. Geriatrics. 2008;63(12):6–12.

    PubMed  Google Scholar 

  33. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. 2008. p. 1–139. http://aidsinfo.nih.gov/contentfiles/adultandadolescentgl001226.pdf. Accessed 10 May 2015.

  34. Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care. 1998;36(1):8–27.

    Article  CAS  PubMed  Google Scholar 

  35. Quan H, Sundararajan V, Halfon P, et al. Coding algorithms for defining comorbidities in ICD-9-CM and ICD-10 administrative data. Med Care. 2005;43(11):1130–9.

    Article  PubMed  Google Scholar 

  36. Hess LM, Raebel MA, Conner DA, Malone DC. Measurement of adherence in pharmacy administrative databases: a proposal for standard definitions and preferred measures. Ann Pharmaco. 2006;40(7–8):1280–8.

    Article  Google Scholar 

  37. Braithwaite RS, Kozal MJ, Chang CH, et al. Adherence, virological and immunological outcomes for HIV-infected veterans starting combination antiretroviral therapies. AIDS. 2007;21(12):1579–89.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Ingersoll KS, Cohen J. The impact of medication regimen factors on adherence to chronic treatment: a review of literature. J Behav Med. 2008;31(3):213–24.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Kong MC, Nahata MC, Lacombe VA, Seiber EE, Balkrishnan R. Association between race, depression, and antiretroviral therapy adherence in a low-income population with HIV infection. J Gen Intern Med. 2012;27(9):1159–64.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Turner BJ, Laine C, Cosler L, Hauck WW. Relationship of gender, depression, and health care delivery with antiretroviral adherence in HIV-infected drug users. J Gen Intern Med. 2003;18(4):248–57.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Pruitt Z, Robst J, Langland-Orban B, Brooks RG. Healthcare costs associated with antiretroviral adherence among Medicaid patients. App Health Econ Health Policy. 2014;13(1):69–80.

    Article  Google Scholar 

  42. Puskas CM, Forrest JI, Parashar S, et al. Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep. 2011;8(4):277–87.

    Article  PubMed  Google Scholar 

  43. Reif S, Golin CE, Smith SR. Barriers to accessing HIV/AIDS care in North Carolina: rural and urban differences. AIDS Care. 2005;17(5):558–65.

    Article  CAS  PubMed  Google Scholar 

  44. Cantudo-Cuenca MR, Jiménez-Galán R, Almeida-González CV, Morillo-Verdugo R. Concurrent use of comedications reduces adherence to antiretroviral therapy among HIV-infected patients. J Manag Care Pharm. 2014;20(8):844–50.

    Google Scholar 

  45. Holtzman C, Armon C, Tedaldi E, et al. Polypharmacy and risk of antiretroviral drug interactions among the aging HIV-infected population. J Gen Intern Med. 2013;28(10):1302–10.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Nguyen N, Holodniy M. HIV infection in the elderly. Clin Interv Aging. 2008;3(3):453–72.

    PubMed  PubMed Central  Google Scholar 

  47. Monroe AK, Rowe TL, Moore RD, Chander G. Medication adherence in HIV-positive patients with diabetes or hypertension: a focus group study. BMC Health Serv Res. 2013;13(1):488.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Saberi P, Dong BJ, Johnson MO, Greenblatt RM, Cocohoba JM. The impact of HIV clinical pharmacists on HIV treatment outcomes: a systematic review. Patient Prefer Adherence. 2012;6:297–322.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Henderson KC, Hindman J, Johnson SC, Valuck RJ, Kiser JJ. Assessing the effectiveness of pharmacy-based adherence interventions on antiretroviral adherence in persons with HIV. AIDS Patient Care STDs. 2011;25(4):221–8.

    Article  PubMed  Google Scholar 

  50. Ma A, Chen DM, Chau FM, Saberi P. Improving adherence and clinical outcomes through an HIV pharmacist’s interventions. AIDS Care. 2010;22(10):1189–94.

    Article  PubMed  Google Scholar 

  51. Abara W, Heiman HJ. The Affordable Care Act and low-income people living with HIV: looking forward in 2014 and beyond. J Assoc Nurses AIDS Care: JANAC. 2014;25(6):476–82.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Cahill SR, Mayer KH, Boswell SL. The Ryan White HIV/AIDS program in the age of health care reform. Am J Public Health. 2015;105(6):1078–85.

    Article  PubMed  Google Scholar 

  53. Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clin Infect Dis. 2006;43(7):939–41.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Community Health and Preventive Medicine, Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive SW, NCPC 214, Atlanta, GA, USA

    Winston E. Abara & Oluwatoyosi A. Adekeye

  2. National Center for Primary Care, Morehouse School of Medicine, 720 Westview Drive SW, NCPC 214, Atlanta, GA, USA

    Junjun Xu & George Rust

  3. Satcher Health Leadership Institute, Morehouse School of Medicine, 720 Westview Drive SW, NCPC 214, Atlanta, GA, USA

    Harry J. Heiman

Authors
  1. Winston E. Abara
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Oluwatoyosi A. Adekeye
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Junjun Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Harry J. Heiman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. George Rust
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Winston E. Abara.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abara, W.E., Adekeye, O.A., Xu, J. et al. Correlates of Combination Antiretroviral Adherence Among Recently Diagnosed Older HIV-Infected Adults Between 50 and 64 years. AIDS Behav 20, 2674–2681 (2016). https://doi.org/10.1007/s10461-016-1325-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-016-1325-x

Keywords

Palabras Clave

Search

Navigation