Pharmacy World and Science

, Volume 28, Issue 4, pp 248–256 | Cite as

Differences in adherence and motivation to HIV therapy—two independent assessments in 1998 and 2002

  • Björn SödergårdEmail author
  • Margit Halvarsson
  • Stefan Lindbäck
  • Anders Sönnerborg
  • Mary P. Tully
  • Åsa Kettis Lindblad
Research Article



The aim of this study was to compare the level of adherence and motivation in two independent cross-sectional samples of HIV-infected patients conducted in 1998 and 2002, and to investigate the relationship between adherence and motivation.


Consecutive HIV-infected patients on treatment at a Swedish clinic were asked to complete an anonymous questionnaire. In 1998, 60 patients participated and in 2002, 53 participated. In 2002, the 9-item Morisky Medication Adherence Scale (MMAS) was added to the questionnaire set.

Main outcome measure

Self-reported adherence and motivation.


In 1998, 28.1% of the respondents were considered adherent, while the corresponding proportion was 57.4% in 2002 (P = 0.002). The mean summary score for MMAS was 10.7 in 2002 (13 = perfect adherence). The proportion considered motivated were 22.4% in the 1998 survey and 41.3% in 2002 (P = 0.038). Of the respondents considered motivated in the 2002 survey, 46.7% scored the maximum summary score on the MMAS, while 8.7% of the non-motivated respondents did so (P = 0.016).


The respondents in 2002 were more adherent and motivated than the respondents in 1998 and a relationship between motivation and adherence was found. The difference in adherence and motivation might be due to a new treatment model at the clinic.


Acquired immunodeficiency syndrome AIDS HIV Highly active antiretroviral therapy MMAS Patient adherence Patient compliance Patient motivation Pharmacotherapy Sweden 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.



We thank the following people for their assistance: Colleagues at the HIV clinic, Karolinska University Hospital – Huddinge and also the colleagues at the Department of Pharmacy, Uppsala University. Supported by the Lennhof foundation, Swedish Pharmaceutical Academy, the Department of Infectious Diseases at Karolinska University Hospital – Huddinge and Hospital Pharmacy, Huddinge University Hospital. Potential conflicts of interest: none declared.


  1. 1.
    Carpenter CC, Fischl MA, Hammer SM, et al. Antiretroviral therapy for HIV infection in 1996. Recommendations of an international panel. International AIDS Society-USA. Jama 1996;276(2):146–54PubMedCrossRefGoogle Scholar
  2. 2.
    Carpenter CC, Fischl MA, Hammer SM, et al. Antiretroviral therapy for HIV infection in 1998: updated recommendations of the International AIDS Society-USA Panel. Jama 1998;280(1):78–86PubMedCrossRefGoogle Scholar
  3. 3.
    Yeni PG, Hammer SM, Carpenter CC, et al. Antiretroviral treatment for adult HIV infection in 2002: updated recommendations of the International AIDS Society-USA Panel. Jama 2002;288(2):222–35PubMedCrossRefGoogle Scholar
  4. 4.
    Schrimshaw EW, Siegel K, Lekas HM. Changes in attitudes toward antiviral medication: a comparison of women living with HIV/AIDS in the pre-HAART and HAART eras. AIDS Behav 2005;9(3):267–79PubMedCrossRefGoogle Scholar
  5. 5.
    Moore RD, Keruly JC, Gebo KA, et al. An improvement in virologic response to highly active antiretroviral therapy in clinical practice from 1996 through 2002. J Acquir Immune Defic Syndr 2005;39(2):195–8PubMedGoogle Scholar
  6. 6.
    Kalkut G. Antiretroviral therapy: an update for the non-AIDS specialist. Curr Opin Oncol 2005;17(5):479–84PubMedCrossRefGoogle Scholar
  7. 7.
    Paterson DL, Swindells S, Mohr J, et al. Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Ann Intern Med 2000;133(1):21–30PubMedGoogle Scholar
  8. 8.
    Liu H, Golin CE, Miller LG, et al. A comparison study of multiple measures of adherence to HIV protease inhibitors. Ann Intern Med 2001;134(10):968–77PubMedGoogle Scholar
  9. 9.
    Arnsten JH, Demas PA, Farzadegan H, et al. Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self-report and electronic monitoring. Clin Infect Dis 2001;33(8):1417–23PubMedCrossRefGoogle Scholar
  10. 10.
    Wagner GJ, Rabkin JG. Measuring medication adherence: are missed doses reported more accurately then perfect adherence? AIDS Care 2000;12(4):405–8PubMedCrossRefGoogle Scholar
  11. 11.
    Cederfjall C, Langius-Eklof A, Lidman K, et al. Self- reported adherence to antiretroviral treatment and degree of sense of coherence in a group of HIV-infected patients. Aids Patient Care STDS 2002;16(12):609–16PubMedCrossRefGoogle Scholar
  12. 12.
    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(4):357–66PubMedCrossRefGoogle Scholar
  13. 13.
    Bangsberg DR, Hecht FM, Charlebois ED, et al. Comparing objective measures of adherence to HIV antiretroviral therapy: electronic medication monitors and unannounced pill counts. AIDS Behav 2001;5(3):275–81CrossRefGoogle Scholar
  14. 14.
    Graney MJ, Bunting SM, Russell CK. HIV/AIDS medication adherence factors: inner-city clinic patient’s self-reports. Tenn Med 2003;96(2):73–8PubMedGoogle Scholar
  15. 15.
    Kalichman SC, Rompa D, DiFonzo K, et al. HIV treatment adherence in women living with HIV/AIDS: research based␣on the Information–Motivation–Behavioral Skills model of health behavior. J Assoc Nurses AIDS Care 2001;12(4):58–67PubMedCrossRefGoogle Scholar
  16. 16.
    Singh N, Berman SM, Swindells S, et al. Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy. Clin Infect Dis 1999;29(4):824–30PubMedGoogle Scholar
  17. 17.
    Horne R. Compliance, adherence and concordance. In: Taylor K, Harding G, editors. Pharmacy practice. London: Taylor & Francis; 2001. p. 165–84Google Scholar
  18. 18.
    Amico KR, Toro-Alfonso J, Fisher JD. An empirical test of the information, motivation and behavioral skills model of␣antiretroviral therapy adherence. AIDS Care 2005;17(6):661–73PubMedCrossRefGoogle Scholar
  19. 19.
    Sandstrom E, Uhnoo I, Ahlqvist-Rastad J, et al. Antiretroviral treatment of human immunodeficiency virus infection: Swedish recommendations. Scand J Infect Dis 2003;35(3):155–67PubMedCrossRefGoogle Scholar
  20. 20.
    Chesney MA, Ickovics JR, Chambers DB, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care 2000;12(3):255–66PubMedCrossRefGoogle Scholar
  21. 21.
    Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986;24(1):67–74PubMedCrossRefGoogle Scholar
  22. 22.
    Viswanathan H, Anderson R, Thomas J, III. Nature and correlates of SF-12 physical and mental quality of life components among low-income HIV adults using an HIV service center. Qual Life Res 2005;14(4):935–44PubMedCrossRefGoogle Scholar
  23. 23.
    Turner BJ, Adherence to antiretroviral therapy by human immunodeficiency virus-infected patients. J Infect Dis 2002;185(Suppl. 2):S143–S151PubMedCrossRefGoogle Scholar
  24. 24.
    Gifford AL, Bormann JE, Shively MJ, et al. Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. J Acquir Immune Defic Syndr 2000;23(5):386–95PubMedGoogle Scholar
  25. 25.
    Haubrich RH, Little SJ, Currier JS, et al. The value of patient-reported adherence to antiretroviral therapy in predicting virologic and immunologic response. California Collaborative Treatment Group. AIDS 1999;13(9):1099–107PubMedCrossRefGoogle Scholar
  26. 26.
    Sodergard BM, Baretta K, Tully MP, et al. A qualitative study of health-care personnel’s experience of a satellite pharmacy at a HIV clinic. Pharm World Sci 2005;27(2):108–15PubMedCrossRefGoogle Scholar
  27. 27.
    Haynes RB, McDonald H, Garg AX, et al. Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev 2002;2:CD000011PubMedGoogle Scholar
  28. 28.
    Golin CE, Liu H, Hays RD, et al. A prospective study of predictors of adherence to combination antiretroviral medication. J Gen Intern Med 2002;17(10):756–65PubMedCrossRefGoogle Scholar
  29. 29.
    Claxton AJ, Cramer J, Pierce C. A systematic review of the associations between dose regimens and medication compliance. Clin Therap 2001;23(8):1296–310CrossRefGoogle Scholar
  30. 30.
    Spire B, Duran S, Souville M, et al. Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: from a predictive to a dynamic approach. Soc Sci Med 2002;54(10):1481–96PubMedCrossRefGoogle Scholar
  31. 31.
    Gordillo V, del Amo J, Soriano V, et al. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS 1999;13(13):1763–9PubMedCrossRefGoogle Scholar
  32. 32.
    Stockwell Morris L, Schultz RM. Patient compliance—an overview. J Clin Pharm Therap 1992;17:283–295Google Scholar
  33. 33.
    Bangsberg DR, Charlebois ED, Grant RM, et al. High levels of adherence do not prevent accumulation of HIV drug resistance mutations. AIDS 2003;17(13):1925–32PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2006

Authors and Affiliations

  • Björn Södergård
    • 1
    • 2
    Email author
  • Margit Halvarsson
    • 3
  • Stefan Lindbäck
    • 3
  • Anders Sönnerborg
    • 4
  • Mary P. Tully
    • 1
    • 5
  • Åsa Kettis Lindblad
    • 1
  1. 1.Pharmaceutical Outcomes Research Group, Department of PharmacyUppsala UniversityUppsalaSweden
  2. 2.Hospital pharmacyKarolinska University Hospital – HuddingeStockholmSweden
  3. 3.HIV ClinicKarolinska University HospitalHuddingeSweden
  4. 4.Divisions of Infectious Diseases and Clinical Virology, Karolinska InstitutetKarolinska University HospitalHuddingeSweden
  5. 5.School of Pharmacy and Pharmaceutical SciencesUniversity of ManchesterManchesterUK

Personalised recommendations