AIDS and Behavior

, Volume 20, Issue 5, pp 1060–1067 | Cite as

Antiretroviral Refill Adherence Correlates with, But Poorly Predicts Retention in HIV Care

  • Robert A. Bonacci
  • Katherine Frasca
  • Lyles Swift
  • Daohang Sha
  • Warren B. Bilker
  • Laura Bamford
  • Baligh R. Yehia
  • Robert Gross
Original Paper
First Online:

Abstract

If antiretroviral refill adherence could predict non-retention in care, it could be clinically useful. In a retrospective cohort study of HIV-infected adults in Philadelphia between October 2012 and April 2013, retention in care was measured by show versus no-show at an index visit. Three measures of adherence were defined per person: (1) percent of doses taken for two refills nearest index visit, (2) days late for last refill before index visit, and (3) longest gap between any two refills. Of 393 patients, 108 (27.4 %) no-showed. Adherence was higher in the show group on all measures with longest gap having the greatest difference: 40 days (IQR 33–56) in the show versus 47 days (IQR 38–69) in the no-show group, p < 0.001. Yet, no cut-points of adherence adequately predicted show versus no-show. Antiretroviral adherence being associated, but a poor predictor of retention suggests that these two behaviors are related but distinct phenomena.

Keywords

HIV Adherence Antiretroviral therapy Retention in care Monitoring 

Resumen

Si adherencia al tratamiento antirretroviral (TAR) pudiera pronosticar la continuidad del cuidado, tendría un beneficio clínico. En este estudio del cohorte retrospectivo de adultos infectados con el VIH en Filadelfia entre el mes de Octubre 2012 y el mes de Abril 2013, la continuidad del cuidado se midió por gente que asisten contra gente que no asisten a la visita principal. Tres medidas de adherencia se definieron por persona: 1) el porcentaje de dosis tomados por las dos recetas surtidas más cercanas a la visita principal, 2) los días atrasados recogiendo el último surtido antes de la visita principal, y 3) el periodo más largo entre el surtido de dos recetas. De 393 pacientes, 108 pacientes (27.4 %) no se presentaron. La adherencia fue más alta en el grupo que asistió por todas las medidas, con el periodo más largo demostrando la diferencia más grande: 40 días (rango intercuartil [RIQ], 33-56) con el grupo que asistió contra 47 días (RIQ, 38-69) con el grupo que no asistió, p < 0.001. Sin embargo, no hubo ningún punto de adherencia que pronosticara precisamente asistir contra no asistir. La adherencia al TAR siendo relacionado, pero un predictor débil de la continuidad del cuidado sugiere que estos dos comportamientos son fenómenos relacionados pero distintos.

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Notes

Acknowledgements

We thank the staff at The Jonathan Lax Treatment Center of Philadelphia FIGHT for assisting in assembling the retrospective cohort. As well, authors thank Robert Marcinko of Walgreens Pharmacy for ART refill data acquisition, and Carolina Bonacci for assistance with the Spanish translation of the abstract. This work was supported by the Infectious Diseases Society of America and the University of Pennsylvania Center for Clinical Epidemiology and Biostatistics [to RAB], the National Institutes of Health [K23-MH097647 to BRY], and core services and support of the Penn Center for AIDS Research [P30 AI 045008 to RG]. Funding agencies did not participate in study design, nor did they have participation in the decision to submit the paper for publication. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Compliance with Ethical Standards

Conflict of Interest

None.

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Copyright information

© Springer Science+Business Media New York (outside the USA) 2015

Authors and Affiliations

  1. 1.Center for Clinical Epidemiology and BiostatisticsUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  2. 2.Department of Medicine (Infectious Diseases)University of Pennsylvania Perelman School of MedicinePhiladelphiaUSA
  3. 3.The Jonathan Lax Treatment CenterPhiladelphia FIGHTPhiladelphiaUSA
  4. 4.Department of Medicine (Infectious Diseases)Corporal Michael J. Crescenz Veterans Affairs Medical CenterPhiladelphiaUSA

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