AIDS and Behavior

, Volume 15, Issue 7, pp 1410–1415 | Cite as

Risk Factors for Medication Non-Adherence in an HIV Infected Population in the Dominican Republic

  • Julian Harris
  • Mara Pillinger
  • Deborah Fromstein
  • Bayardo Gomez
  • Ivelisse Garris
  • Peter A. Kanetsky
  • Pablo Tebas
  • Robert Gross
Original Paper

Abstract

High levels of medication adherence are central to HIV treatment success. Barriers to medication adherence may differ by cultural setting. We aimed to determine risk factors for medication non-adherence in HIV infected individuals in the Dominican Republic. Adherence was measured in 300 individuals using a visual analog scale assessing the prior month and dichotomized at 95%. High levels of adherence were reported by 228 (76%). Risk factors for non-adherence included heavy alcohol use: 2.5 times odds (95% CI: 1.4–4.5), having children: 2.2 times higher odds (95% CI: 1.1–4.9) and perceptions of less social support related to adherence: 2 times higher odds (95% CI: 1.1–3.6). Culturally appropriate interventions are needed to address alcohol use, which is common in this setting. Parenting may represent a competing demand on time and resources and be an adherence barrier. Self-reported perceived lack of adherence support may be a useful marker for need for adherence interventions.

Keywords

HIV-1 Antiretroviral therapy Adherence Developing world 

References

  1. 1.
    Gross R, Bilker WB, Friedman HM, Strom BL. Effect of adherence to newly initiated antiretroviral therapy on plasma viral load. AIDS. 2001;15:2109–17.PubMedCrossRefGoogle Scholar
  2. 2.
    Bangsberg DR, Hecht FM, Charlebois ED, et al. Adherence to protease inhibitors, HIV-1 viral load, and development of drug resistance in an indigent population. AIDS. 2000;14:357–66.PubMedCrossRefGoogle Scholar
  3. 3.
    Wood E, Hogg RS, Yip B, Harrigan PR, O’Shaughnessy MV, Montaner JS. Effect of medication adherence on survival of HIV-infected adults who start highly active antiretroviral therapy when the CD4 + cell count is 0.200 to 0.350 × 10(9) cells/L. Ann Internal Med. 2003;139:810–6.Google Scholar
  4. 4.
    Nachega JB, Hislop M, Dowdy DW, et al. Adherence to highly active antiretroviral therapy assessed by pharmacy claims predicts survival in HIV-infected South African adults. J Acquir Immune Defic Syndr. 2006;43:78–84.PubMedCrossRefGoogle Scholar
  5. 5.
    Mills EJ, Nachega JB, Buchan I, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA. 2006;296:679–90.PubMedCrossRefGoogle Scholar
  6. 6.
    Bisson GP, Rowh A, Weinstein R, Gaolathe T, Frank I, Gross R. Antiretroviral failure despite high levels of adherence: discordant adherence-response relationship in Botswana. J Acquir Immune Defic Syndr. 2008;49:107–10.PubMedCrossRefGoogle Scholar
  7. 7.
    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.PubMedGoogle Scholar
  8. 8.
    Arnsten JH, Demas PA, Grant RW, et al. Impact of active drug use on antiretroviral therapy adherence and viral suppression in HIV-infected drug users. J Gen Intern Med. 2002;17:377–81.PubMedGoogle Scholar
  9. 9.
    Holmes WC, Bilker WB, Wang H, Chapman J, Gross R. HIV/AIDS-specific quality of life and adherence to antiretroviral therapy over time. J Acquir Immune Defic Syndr. 2007;46(3):323–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Bouhnik AD, Chesney M, Carrieri P, et al. Nonadherence among HIV-infected injecting drug users: the impact of social instability. J Acquir Immune Defic Syndr. 2002;31 Suppl 3:S149–53.PubMedGoogle Scholar
  11. 11.
    Graham J, Bennett IM, Holmes WC, Gross R. Medication beliefs as mediators of the health literacy-antiretroviral adherence relationship in HIV-infected individuals. AIDS Behav. 2007;11:385–92.PubMedCrossRefGoogle Scholar
  12. 12.
    Tuller DM, Bangsberg DR, Senkungu J, Ware NC, Emenyonu N, Weiser SD. Transportation costs impede sustained adherence and access to HAART in a clinic population in Southwestern Uganda: a qualitative study. AIDS Behav 2009.Google Scholar
  13. 13.
    Harvey KM, Carrington D, Duncan J, et al. Evaluation of adherence to highly active antiretroviral therapy in adults in Jamaica. West Indian Med J. 2008;57:293–7.PubMedGoogle Scholar
  14. 14.
    Olupot-Olupot P, Katawera A, Cooper C, Small W, Anema A, Mills E. Adherence to antiretroviral therapy among a conflict-affected population in Northeastern Uganda: a qualitative study. AIDS. 2008;22:1882–4.PubMedCrossRefGoogle Scholar
  15. 15.
    Millenium Development Goals. UNICEF. Available at: http://www.unicef.org/republicadominicana/english/overview_12559.htm. Accessed 30 October, 2009.
  16. 16.
    Encuesta Demografica y de Salud Republica Dominicana Informe Preliminar. Santo Domingo: Centro de Estudios Sociales y Demograficos; November 2007.Google Scholar
  17. 17.
    Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.PubMedCrossRefGoogle Scholar
  18. 18.
    Giordano TP, Guzman D, Clark R, Charlebois ED, Bangsberg DR. Measuring adherence to antiretroviral therapy in a diverse population using a visual analogue scale. HIV Clin Trials. 2004;5:74–9.PubMedCrossRefGoogle Scholar
  19. 19.
    US Department of Agriculture. Alcoholic Beverages, Chap 9. Dietary Guidelines for Americans. Washington, D.C.: US Government Printing Office; 2005:43-46.Google Scholar
  20. 20.
    Pence BW, Thielman NM, Whetten K, Ostermann J, Kumar V, Mugavero MJ. Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the United States Southeast. AIDS Patient Care STDS. 2008;22:869–77.PubMedCrossRefGoogle Scholar
  21. 21.
    Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52:180–202.PubMedCrossRefGoogle Scholar
  22. 22.
    Samet JH, Horton NJ, Meli S, et al. A randomized controlled trial to enhance antiretroviral therapy adherence in patients with a history of alcohol problems. Antivir Ther. 2005;10:83–93.PubMedGoogle Scholar
  23. 23.
    Parsons JT, Golub SA, Rosof E, Holder C. Motivational interviewing and cognitive-behavioral intervention to improve HIV medication adherence among hazardous drinkers: a randomized controlled trial. J Acquir Immune Defic Syndr. 2007;46:443–50.PubMedCrossRefGoogle Scholar
  24. 24.
    Merenstein D, Schneider MF, Cox C, et al. Association of child care burden and household composition with adherence to highly active antiretroviral therapy in the Women’s Interagency HIV Study. AIDS Patient Care STDS. 2009;23:289–96.PubMedCrossRefGoogle Scholar
  25. 25.
    Carrieri MP, Leport C, Protopopescu C, et al. Factors associated with nonadherence to highly active antiretroviral therapy: a 5-year follow-up analysis with correction for the bias induced by missing data in the treatment maintenance phase. J Acquir Immune Defic Syndr. 2006;41:477–85.PubMedCrossRefGoogle Scholar
  26. 26.
    Catz SL, Kelly JA, Bogart LM, Benotsch EG, McAuliffe TL. Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychol. 2000;19:124–33.PubMedCrossRefGoogle Scholar
  27. 27.
    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;8:141–50.PubMedCrossRefGoogle Scholar
  28. 28.
    Nachega JB, Knowlton AR, Deluca A, et al. Treatment supporter to improve adherence to antiretroviral therapy in HIV-infected South African adults. A qualitative study. J Acquir Immune Defic Syndr. 2006;43 Suppl 1:S127–33.PubMedGoogle Scholar
  29. 29.
    Koenig SP, Leandre F, Farmer PE. Scaling-up HIV treatment programmes in resource-limited settings: the rural Haiti experience. AIDS. 2004;18 Suppl 3:S21–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Behforouz HL, Farmer PE, Mukherjee JS. From directly observed therapy to accompagnateurs: enhancing AIDS treatment outcomes in Haiti and in Boston. Clin Infect Dis. 2004;38 Suppl 5:S429–36.PubMedCrossRefGoogle Scholar
  31. 31.
    Ware NC, Wyatt MA, Bangsberg DR. Examining theoretic models of adherence for validity in resource-limited settings. A heuristic approach. J Acquir Immune Defic Syndr. 2006;43 Suppl 1:S18–22.PubMedGoogle Scholar
  32. 32.
    Abaasa AM, Todd J, Ekoru K, et al. Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda. BMC Health Serv Res. 2008;8:241.PubMedCrossRefGoogle Scholar
  33. 33.
    Grossberg R, Zhang Y, Gross R. A time-to-prescription-refill measure of antiretroviral adherence predicted changes in viral load in HIV. J Clin Epidemiol. 2004;57:1107–10.PubMedCrossRefGoogle Scholar
  34. 34.
    Gross R, Yip B, Re VL III, et al. A simple, dynamic measure of antiretroviral therapy adherence predicts failure to maintain HIV-1 suppression. J Infect Dis. 2006;194:1108–14.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Julian Harris
    • 1
  • Mara Pillinger
    • 2
  • Deborah Fromstein
    • 3
  • Bayardo Gomez
    • 4
  • Ivelisse Garris
    • 5
  • Peter A. Kanetsky
    • 6
  • Pablo Tebas
    • 7
    • 8
  • Robert Gross
    • 6
    • 7
    • 8
  1. 1.Department of Medicine (Resident)Brigham & Women’s Hospital, Harvard Medical SchoolBostonUSA
  2. 2.School of Arts and SciencesUniversity of PennsylvaniaPhiladelphiaUSA
  3. 3.Department of Medicine (Resident)University of WashingtonWashington, DCUSA
  4. 4.Health Promotion and Human Solidarity Center (CEPROSH)Puerto PlataDominican Republic
  5. 5.Galvan Health CenterSanto DomingoDominican Republic
  6. 6.Center for Clinical Epidemiology and BiostatisticsUniversity of Pennsylvania School of MedicinePhiladelphiaUSA
  7. 7.Department of Medicine (Infectious Diseases)University of Pennsylvania School of MedicinePhiladelphiaUSA
  8. 8.Center for AIDS Research (CFAR)University of PennsylvaniaPhiladelphiaUSA

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