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Memory-Based Strategies for Antiretroviral Medication Management: An Evaluation of Clinical Predictors, Adherence Behavior Awareness, and Effectiveness

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Abstract

“Forgetting” is the most commonly endorsed reason for missing an antiretroviral therapy (ART) dose, yet little is known about the prevalence, predictors, and effectiveness of the mnemonic strategies to support ART adherence. The current study assessed 28 self-reported memory-based medication strategies in 233 HIV-infected individuals with 30-day ART adherence measured via the medication event monitoring system. Participants endorsed using multiple (8.7 ± 5.6) strategies with the most common being internally-driven. More frequent strategy use was uniquely associated with affective distress, dependent daily functioning, higher non-ART pill burden, and poorer ART adherence. Individuals who used strategies frequently, but perceived them as minimally effective, had more affective, physical, and functional distress. More frequent strategy use was associated with worse ART adherence and was unrelated to perceived effectiveness. Primary reliance on internally-based mnemonic strategies may reflect a lack of awareness of adherence behaviors and may be insufficient to support optimal ART adherence in vulnerable populations.

Resumen

“Olvidar” es la razón mas común para saltarse una dosis de terapia antirretroviral (ART por sus siglas en Inglés), pero poco se sabe acerca de la prevalencia, factores predictivos y la eficacia de la estrategias mnemónicas que ayudan el ART. El presente estudio evaluó 28 estrategias de memoria que ayudan a recordar tomar los medicamentos. Estas estrategias fueron reportadas por los mismos individuos. El estudio evaluó 233 individuos infectados con VIH durante un periodo de 30 días en los cuales se les monitoreó la adherencia a los medicamentos utilizando el sistema de supervisión de eventos de medicamentos (MEMS, por sus siglas en Inglés). Los participants reportaron usar multiples estrategias (8.7 ± 5.6) siendo la más común una estrategia derivada internamente. El uso frecuente de estrategias fue asociado singularmente con el sufrimiento afectivo, dependencia en el funcionanmiento en la vida diaria, la carga asociada a tomar otros medicamentos diferentes al ART, y la pobre aderencia al ART. Los individuos que usaron las estrategias frequentemente, pero que las percibieron como poco efectivas, experimentaron más sufrimiento afectivo, físico y funcional. El uso frequente de las estrategias estuvo asociado con una peor aderencia a los ART y no estuvo relacionado con la percepción de la eficacia. El depender principalmente de estrategias de memoria que son basadas internamente puede reflejar una falta de conciencia sobre los comportamientos de adherencia y puede no ser suficiente para obtener una aderencia optima a los ARTs en poblaciones vulnerables.

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Acknowledgments

This work was supported by the National Institute of Mental Health (MH078785, MH073419 and MH62512), California HIV/AIDS Research Program IDEA Award (ID06-SD-201), and T32 NIDA Grant DA031098. The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, nor the United States Government.

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Authors and Affiliations

  1. California Joint Doctoral Program in Clinical Psychology, San Diego State University/University of San Diego, San Diego, CA, USA

    K. Blackstone & E. Weber

  2. Department of Psychiatry, University of California, 220 Dickinson Street, Suite B, San Diego, CA, 92103, USA

    S. P. Woods, I. Grant & D. J. Moore

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The HNRP Group

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Correspondence to S. P. Woods.

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The member of this HNRP study group are listed in appendix

Appendix

Appendix

The San Diego HIV Neurobehavioral Research Center [HNRC] group is affiliated with the University of California, San Diego, the Naval Hospital, San Diego, and the Veterans Affairs San Diego Healthcare System, and includes: Director: Robert Heaton, Ph.D.; Co-Directors: J. Hampton Atkinson, M.D., Ronald J. Ellis, M.D., Ph.D., and J. Allen McCutchan, M.D.; Center Manager: Thomas D. Marcotte, Ph.D.; Jennifer Marquie-Beck, M.P.H.; Melanie Sherman; Neuromedical Component Ronald J. Ellis, M.D., Ph.D. (P.I.), J. Allen McCutchan, M.D., Scott Letendre, M.D., Edmund Capparelli, Pharm.D., Rachel Schrier, Ph.D., Terry Alexander, R.N., Debra Rosario, M.P.H., Shannon LeBlanc; Neurobehavioral Component Robert K. Heaton, Ph.D. (P.I.), Steven Paul Woods, Psy.D., Mariana Cherner, Ph.D., David J. Moore, Ph.D., Matthew Dawson; Neuroimaging Component Terry Jernigan, Ph.D. (P.I.), Christine Fennema-Notestine, Ph.D., Sarah L. Archibald, M.A., John Hesselink, M.D., Jacopo Annese, Ph.D., Michael J. Taylor, Ph.D.; Neurobiology Component Eliezer Masliah, M.D. (P.I.), Cristian Achim, M.D., Ph.D., Ian Everall, FRCPsych., FRCPath., Ph.D. (Consultant); Neurovirology Component Douglas Richman, M.D., (P.I.), David M. Smith, M.D.; International Component J. Allen McCutchan, M.D., (P.I.); Developmental Component Cristian Achim, M.D., Ph.D.; (P.I.), Stuart Lipton, M.D., Ph.D.; Participant Accrual and Retention Unit J. Hampton Atkinson, M.D. (P.I.), Jenifer Marquie Beck, M.P.H.; Data Management Unit: Anthony C. Gamst, Ph.D. (P.I.), Clint Cushman (Data Systems Manager); Statistics Unit Ian Abramson, Ph.D. (P.I.), Florin Vaida, Ph.D., Reena Deutsch, Ph.D., Anya Umlauf, M.S.

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Blackstone, K., Woods, S.P., Weber, E. et al. Memory-Based Strategies for Antiretroviral Medication Management: An Evaluation of Clinical Predictors, Adherence Behavior Awareness, and Effectiveness. AIDS Behav 17, 74–85 (2013). https://doi.org/10.1007/s10461-012-0308-9

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