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Four Types of Barriers to Adherence of Antiretroviral Therapy are Associated with Decreased Adherence Over Time

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Abstract

The objectives of this study were to understand how different types of barriers to adherence to antiretroviral therapy (ART) were related and their differential impact on objectively measured adherence over time. Data from 151 patients taking ART were used to describe four sub-types of self-reported adherence barriers: medication and health concerns (MHC), stigma (S), family responsibilities (FR), and problems with schedule and routine (PSR). Generalized linear models with generalized estimating equations (GEE) were used to examine the impact of barriers on adherence over time. The sample was 23 % female, mean age 42 years, with 26 % African-American and 20 % Hispanic. The overall average adherence was 73 %. Patients reported at least one PSR barrier in 66 % of study visits, MHC in 40 %, S in 17 %, and FR in 6 %. In 40 % of visits, patients reported two or more barrier sub-types. There were statistically significant (p ≤ 0.05) decreases of 3.9, 2.5, and 2.4 in percent adherence, for MHC, PSR, and S, respectively, per unit increase in barrier score. Interventions to address different types of patient-identified barriers to ART adherence using targeted approaches are needed.

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References

  1. Bangsberg DR, Perry S, Charlebois ED, et al. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS. 2001;15(9):1181–3.

    Article  CAS  PubMed  Google Scholar 

  2. Mills EJ, Nachega JB, Bangsberg DR, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;3(11):e438.

    Article  PubMed Central  PubMed  Google Scholar 

  3. Ammassari A, Trotta MP, Murri R, et al. Correlates and predictors of adherence to highly active antiretroviral therapy: overview of published literature. J Acquir Immune Defic Syndr. 2002;31(Suppl 3):S123–7.

    Article  PubMed  Google Scholar 

  4. Chesney M. Adherence to HAART regimens. AIDS Patient Care STDS. 2003;17(4):169–77.

    Article  PubMed  Google Scholar 

  5. Fogarty L, Roter D, Larson S, Burke J, Gillespie J, Levy R. Patient adherence to HIV medication regimens: a review of published and abstract reports. Patient Educ Couns. 2002;46(2):93–108.

    Article  PubMed  Google Scholar 

  6. Konkle-Parker DJ, Erlen JA, Dubbert PM. Barriers and facilitators to medication adherence in a southern minority population with HIV disease. J Assoc Nurses AIDS Care. 2008;19(2):98–104.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Konkle-Parker D. Medication adherence: what are the barriers and facilitators? HIV Clin. 2007;19(4):8–9.

    PubMed  Google Scholar 

  8. Roberts KJ. Barriers to and facilitators of HIV-positive patients’ adherence to antiretroviral treatment regimens. AIDS Patient Care STDS. 2000;14(3):155–68.

    Article  CAS  PubMed  Google Scholar 

  9. Roberts KJ, Mann T. Barriers to antiretroviral medication adherence in HIV-infected women. AIDS Care. 2000;12(4):377–86.

    Article  CAS  PubMed  Google Scholar 

  10. Proctor VE, Tesfa A, Tompkins DC. Barriers to adherence to highly active antiretroviral therapy as expressed by people living with HIV/AIDS. AIDS Patient Care STDS. 1999;13(9):535–44.

    Article  CAS  PubMed  Google Scholar 

  11. Murphy DA, Roberts KJ, Martin DJ, Marelich W, Hoffman D. Barriers to antiretroviral adherence among HIV-infected adults. AIDS Patient Care STDS. 2000;14(1):47–58.

    Article  CAS  PubMed  Google Scholar 

  12. Remien RH, Hirky AE, Johnson MO, Weinhardt LS, Whittier D, Le GM. Adherence to medication treatment: a qualitative study of facilitators and barriers among a diverse sample of HIV+ men and women in four US cities. AIDS Behav. 2003;7(1):61–72.

    Article  PubMed  Google Scholar 

  13. Vervoort SC, Borleffs JC, Hoepelman AI, Grypdonck MH. Adherence in antiretroviral therapy: a review of qualitative studies. AIDS. 2007;21(3):271–81.

    Article  PubMed  Google Scholar 

  14. Rao D, Kekwaletswe TC, Hosek S, Martinez J, Rodriguez F. Stigma and social barriers to medication adherence with urban youth living with HIV. AIDS Care. 2007;19(1):28–33.

    Article  CAS  PubMed  Google Scholar 

  15. Wilson IB, Laws MB, Safren SA, et al. Provider-focused intervention increases adherence-related dialogue but does not improve antiretroviral therapy adherence in persons with HIV. J Acquir Immune Defic Syndr. 2010;53(3):338–47.

    Article  PubMed Central  PubMed  Google Scholar 

  16. Rogers WH, Wilson IB, Bungay KM, Cynn DJ, Adler DA. Assessing the performance of a new depression screener for primary care (PC-SAD). J Clin Epidemiol. 2002;55(2):164–75.

    Article  PubMed  Google Scholar 

  17. Genberg BL, Wilson IB, Bangsberg DR, et al. Patterns of antiretroviral therapy adherence and impact on HIV RNA among patients in North America. AIDS. 2012;26(11):1415–23.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  18. Bangsberg DR, Kroetz DL, Deeks SG. Adherence-resistance relationships to combination HIV antiretroviral therapy. Curr HIV/AIDS Rep. 2007;4(2):65–72.

    Article  PubMed  Google Scholar 

  19. Norton WE, Amico KR, Fisher WA, et al. Information-motivation-behavioral skills barriers associated with intentional versus unintentional ARV non-adherence behavior among HIV + patients in clinical care. AIDS Care. 2010;22(8):979–87.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Vervoort SC, Grypdonck MH, de Grauwe A, Hoepelman AI, Borleffs JC. Adherence to HAART: processes explaining adherence behavior in acceptors and non-acceptors. AIDS Care. 2009;21(4):431–8.

    Article  PubMed  Google Scholar 

  21. MacDonell K, Naar-King S, Huszti H, Belzer M. Barriers to medication adherence in behaviorally and perinatally infected youth living with HIV. AIDS Behav. 2013;17(1):86–93.

    Article  PubMed Central  PubMed  Google Scholar 

  22. Murphy DA, Sarr M, Durako SJ, et al. Barriers to HAART adherence among human immunodeficiency virus-infected adolescents. Arch Pediatr Adolesc Med. 2003;157(3):249–55.

    Article  PubMed  Google Scholar 

  23. Simoni JM, Amico KR, Pearson CR, Malow R. Strategies for promoting adherence to antiretroviral therapy: a review of the literature. Curr Infect Dis Rep. 2008;10(6):515–21.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Mbuagbaw L, van der Kop ML, Lester RT et al. Mobile phone text messages for improving adherence to antiretroviral therapy (ART): an individual patient data meta-analysis of randomised trials. BMJ Open 2013;3(12):e003950.

    Google Scholar 

  25. Feldman BJ, Fredericksen RJ, Crane PK, et al. Evaluation of the single-item self-rating adherence scale for use in routine clinical care of people living with HIV. AIDS Behav. 2013;17(1):307–18.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  26. Schackman BR, Dastur Z, Rubin DS, et al. Feasibility of using audio computer-assisted self-interview (ACASI) screening in routine HIV care. AIDS Care. 2009;21(8):992–9.

    Article  PubMed  Google Scholar 

  27. Gonzalez JS, Batchelder AW, Psaros C, Safren SA. Depression and HIV/AIDS treatment nonadherence: a review and meta-analysis. J Acquir Immune Defic Syndr. 2011;58(2):181–7.

    PubMed  Google Scholar 

  28. Starace F, Ammassari A, Trotta MP, et al. Depression is a risk factor for suboptimal adherence to highly active antiretroviral therapy. J Acquir Immune Defic Syndr. 2002;31(Suppl 3):S136–9.

    Article  PubMed  Google Scholar 

  29. Wendel CS, Mohler MJ, Kroesen K, Ampel NM, Gifford AL, Coons SJ. Barriers to use of electronic adherence monitoring in an HIV clinic. Ann Pharmacother. 2001;35(9):1010–5.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

This work was supported by grants from the National Institute on Drug Abuse (R01DA015679, R21MH073420), the National Institute for Mental Health (R21MH073420; K24MH092242), and the Lifespan/Tufts/Brown Centers for AIDS Research (P30AI042853).

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Authors and Affiliations

  1. Program in Public Health, Department of Health Services, Policy & Practice, Brown University, Box G-121-6, 121 South Main Street, Providence, RI, 02912, USA

    Becky L. Genberg, Yoojin Lee & Ira B. Wilson

  2. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA

    William H. Rogers

Authors
  1. Becky L. Genberg
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  2. Yoojin Lee
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  3. William H. Rogers
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  4. Ira B. Wilson
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Correspondence to Becky L. Genberg.

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Genberg, B.L., Lee, Y., Rogers, W.H. et al. Four Types of Barriers to Adherence of Antiretroviral Therapy are Associated with Decreased Adherence Over Time. AIDS Behav 19, 85–92 (2015). https://doi.org/10.1007/s10461-014-0775-2

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  • DOI: https://doi.org/10.1007/s10461-014-0775-2

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