Journal of General Internal Medicine

, Volume 21, Issue 8, pp 835–840

Health literacy, antiretroviral adherence, and HIV-RNA suppression

A longitudinal perspective
  • Michael K. Paasche-Orlow
  • Debbie M. Cheng
  • Anita Palepu
  • Seville Meli
  • Vincent Faber
  • Jeffrey H. Samet
Original Articles

DOI: 10.1111/j.1525-1497.2006.00527.x

Cite this article as:
Paasche-Orlow, M.K., Cheng, D.M., Palepu, A. et al. J GEN INTERN MED (2006) 21: 835. doi:10.1111/j.1525-1497.2006.00527.x

Abstract

BACKGROUND: Low health literacy has been associated with worse adherence to antiretroviral therapy (ART) and higher HIV-RNA levels, but these relationships have not been evaluated in longitudinal analyses.

METHODS: We evaluated literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) (≤6th grade, 7th to 8th grade, ≥9th grade) in the HIV-Alcohol Longitudinal Cohort study of HIV-infected persons with a history of alcohol problems, conducted from 1997 to 2001. We tested HIV-RNA levels and administered a standardized questionnaire regarding demographics, substance use, receipt of ART, and adherence with ART, every 6 months for up to 7 occasions. Among the 235 subjects on ART, we investigated the relationship between literacy and 2 outcomes: 100% 3-day self-reported adherence and HIV-RNA suppression (<500 copies).

RESULTS: Subjects’ literacy levels were the following: 14% ≤6th grade, 29% 7th to 8th grade, and 57% ≥9th grade. In 66% of the observations (478/725), subjects reported 100% 3-day adherence with ART. Of the 685 HIV-RNA assays from these subjects, 62% had <500 copies. In unadjusted analyses, subjects with the lowest literacy level (≤6th grade) had a higher odds of adherence (odds ratio [OR] 2.23, 95% confidence interval 1.15 to 4.30) and HIV-RNA suppression (OR 2.01, 95% confidence interval 1.03 to 3.90) compared with those with ≥9th grade literacy. This trend persisted but was no longer statistically significant in adjusted models of adherence (AOR 1.93, 95% confidence interval 0.86 to 4.31) and HIV-RNA suppression (AOR 1.70, 95% confidence interval 0.79 to 3.65).

CONCLUSION: Contrary to our hypothesis, low literacy was not associated with a lower odds of adherence or virologic suppression in this longitudinal analysis of HIV-infected patients with a history of alcohol problems. Indeed, trends in these data suggest the possibility that low literacy may be associated with a higher odds of adherence and virologic suppression. These counterintuitive findings underscore the need to pursue a fuller understanding of the mechanisms by which literacy affects health outcomes.

Key words

HIV adherence health literacy literacy 

Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Michael K. Paasche-Orlow
    • 1
  • Debbie M. Cheng
    • 1
  • Anita Palepu
    • 2
  • Seville Meli
    • 1
  • Vincent Faber
    • 3
  • Jeffrey H. Samet
    • 1
  1. 1.Section of General Internal Medicine, Department of MedicineBoston University School of MedicineBoston
  2. 2.University of British ColumbiaVancouverCanada
  3. 3.DM-StatMedfordUSA

Personalised recommendations