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Predictors of Adherence with Triple Combination Antiretroviral Therapy V. MONTESSORI, K. V. HEATH, B. YIP, R. S. HOGG, M. V. O'SHAUGHNESSY, and J. S. G. MONTANER.
BC Ctr. for Excellence in HIV/AIDS, Vancouver, Canada Objective: To identify determinants of adherence with triple combination antiretroviral (ARV) therapy among individuals participating in a population-based anti-HIV drug treatment program in British Columbia (BC).
Methods: In BC, ARV is provided free of charge in accordance with specific treatment guidelines. Study subjects were ARV naïve and initiated triple therapy with 2 NRTIs plus either a PI or NNRTI between 08/96-10/98. Adherence was estimated by dividing the number of months of documented prescriptions dispensed by the number of months of follow-up in the first year of ARV. Stepwise logistic regression was used to identify patient and physician characteristics independently associated with being 95%-100% adherent in the first year of follow-up. All p-values are two-sided.
Results: A total of 886 individuals (766 men and 120 women) were studied of whom 504 (57%) were 95% to 100% adherent to therapy. The median duration of treatment was 14 months (IQR 8-21) and median baseline CD4 count was 290 cells/mm3 (IQR 130-440). In our multivariate analysis adherence with triple ARV therapy was positively associated with increased age [per every 10 year increase] (AOR 1.33; 95% CI 1.12-1.57), having an AIDS diagnosis at baseline (AOR 2.28; 95% CI 1.44-3.61), being male (AOR 1.96; 95% CI 1.28-3.01), and increased experience of the treating physician [per every increase of 100 HIV+ patients] (AOR 1.45; 95%CI 1.20-1.74). Having ever used injection drugs was negatively associated with adherence (AOR 0.50; 95% CI 0.36-0.71). All p-values were < 0.001.
Conclusion: These findings demonstrate that patient characteristics and disease stage may play an important role in the ability to comply with complex therapeutic regimens. Particular attention should be paid to designing therapeutic regimens for individuals who are current or former injection drug users who, in this study, were half as likely to be 95% or more adherent to therapy as those who had never used injection drugs. Moreover, physicians with greater experience in treating HIV disease may have greater success in maintaining patients on prescribed therapy.
Key Words: Adherence, Physician experience, Population Health
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