Journal of General Internal Medicine

, Volume 14, Issue 5, pp 267–273 | Cite as

Adherence to combination antiretroviral therapies in HIV patients of low health literacy

  • Seth C. Kalichman
  • Bineetha Ramachandran
  • Sheryl Catz
Original Articles


OBJECTIVE: To test the significance of health literacy relative to other predictors of adherence to treatment for HIV and AIDS.

PARTICIPANTS: Community sample of HIV-seropositive men (n=138) and women (n=44) currently taking a triple-drug combination of antiretroviral therapies for HIV infection; 60% were ethnic minorities, and 73% had been diagnosed with AIDS.

MEASUREMENTS: An adapted form of the Test of Health Literacy in Adults (TOFHLA), a comprehensive health and treatment interview that included 2-day recall of treatment adherence and reasons for nonadherence, and measures of substance abuse, social support, emotional distress, and attitudes toward primary care providers.

MAIN RESULTS: Multiple logistic regression showed that education and health literacy were significant and independent predictors of 2-day treatment adherence after controlling for age, ethnicity, income, HIV symptoms, substance abuse, social support, emotional distress, and attitudes toward primary care providers. Persons of low literacy were more likely to miss treatment doses because of confusion, depression, and desire to cleanse their body than were participants with higher health literacy.

CONCLUSIONS: Interventions are needed to help persons of low literacy adhere to antiretroviral therapies.

Key words

HIV infection AIDS treatment medication adherence 


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Copyright information

© Society of General Internal Medicine 1999

Authors and Affiliations

  • Seth C. Kalichman
    • 2
  • Bineetha Ramachandran
    • 1
  • Sheryl Catz
    • 2
  1. 1.Georgia State UniversityAtlanta
  2. 2.Center for AIDS Intervention Research (CAIR)Medical College of WisconsinMilwaukee

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