Abstract
The purpose of this study was to assess the degree of suboptimal antiretroviral therapy adherence to dose, schedule, and dietary instructions and to examine the effects of extra-personal, intra-personal, and inter-personal factors on suboptimal adherence across the three types of instructions. Self-report and clinical data were collected from 193 sexually infected Swedish patients receiving ART. Effects of extra-personal, intra-personal, and inter-personal factors on suboptimal adherence were examined using multivariate logistic regression models. Suboptimal adherence to dose instructions was recorded in 12% of patients. Equivalent percentage for suboptimal adherence to schedule instructions was 37% and for suboptimal adherence to dietary instructions 58%. Anxiety was the only risk factor for suboptimal adherence to dose. Heavy pill burden was a risk factor for suboptimal adherence to schedule. Older age and HIV-related post-traumatic stress disorder (PTSD) symptoms decreased the risk of suboptimal adherence to schedule. No factors investigated had an effect on suboptimal adherence to dietary instructions. To improve adherence to dose and schedule instructions, clinicians caring for patients with HIV should assess and treat anxiety and be alert to HIV-related PTSD symptoms.
Similar content being viewed by others
References
Altice, F. L., Mostashari, F., & Friedland, G. H. (2001). Trust and acceptance of and adherence to antiretroviral therapy. Journal of Acquired Immune Deficiency Syndrome, 28, 47–58.
Ammassari, A., Murri, R., Pezzotti, P., Trotta, M. P., Ravasio, L., De Longis, P., et al. (2001). Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. Journal of Acquired Immune Deficiency Syndrome, 28, 445–449.
Ammassari, A., Trotta, M. P., Murri, R., Castelli, F., Narcisco, P., Noto, P., et al. (2002). Correlates and predictors of adherence to highly active antiretroviral therapy: Overview of published literature. Journal of Acquired Immune Deficiency Syndrome, 31(Suppl. 3), S123–S127.
Bartlett, J. A. (2002). Addressing the challenges of adherence. Journal of Acquired Immune Deficiency Syndrome, 29(Suppl. 3), S2–S10.
Bartlett, J. A., DeMasi, R., & Quinn, J. (2001). Overview of the effectiveness of triple combination therapy in antiretroviral-naive HIV-1 infected adults. AIDS, 15, 1369–1377.
Beck, A., Weissman, A., Lester, D., & Trezler, L. (1974). The measurement of pessimism: The Hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861–865.
Begley, K. (2004). A behavioral model of protease inhibitor non-adherence: theoretical and clinical implications. Thesis. School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales.
Catz, S. L., Kelly, J. A., Bogart, L. M., Benotsch, E. G., & McAuliffe, T. (2000). Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease. Health Psychology, 19, 124–133.
Cederfjäll C. (2002). Aspects of care among HIV-infected patients. Needs, adherence to treatment and health related quality of life. Stockholm, Sweden: Dissertation, Karolinska Institute.
Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., et al. (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: The AACTG adherence instruments. AIDS Care, 12, 255–266.
Delahanty, D. L., Bogart, L. M., & Figler, J. L. (2004). Posttraumatic stress disorder symptoms, salivary cortisol, medication adherence, and CD4 levels in HIV-positive individuals. AIDS Care, 16, 47–260.
Derogatis, I., & Melisatanos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine, 13, 595–605.
Duran, S., Spire, B., Raffi, F., Walter, V., Bouhour, D., Journot, V., et al. (2001). Self-reported symptoms after initiation of a protease inhibitor in HIV-infected patients and their impact on adherence to HAART. HIV Clinical Trials, 2, 38–45.
Eldred, L. J., Wu, A. W., Chaisson, R. E., & Moore, R. D. (1998). Adherence to antiretroviral and Pneumocystis prophylaxis in HIV disease. Journal of Acquired Immune Deficiency Syndrome, 18, 117–125.
Gao, X., Nau, D. P., Rosenbluth, S. A., Scott, V., & Woodward, C. (2000). The relationship of disease severity, health beliefs and medication adherence among HIV patients. AIDS Care, 12, 387–398.
Gifford, A., Borman, J., Shivley, M., Wright, B. C., Richman, D. D., & Bozette, S. A. (2000). Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. Journal of Acquired Immune Deficiency Syndrome, 23, 386–395.
Godin, G., Coté, J., Naccache, H., Lambert, L. D., & Trottier, S. (2005). Prediction of adherence to antiretroviral therapy: A one-year longitudinal study. AIDS Care, 17, 493–504.
Gordillo, V., del Amo, J., Soriano, V., & Gonzalez-Lahoz, J. (1999). Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS, 13, 1763–1769.
Horowitz, M. J., Wilner, N. R., & Alvarez, W. (1979). Impact of event scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–218.
Ingersoll, K. (2004). The impact of psychiatric symptoms, drug use, and medication regimen on non-adherence to HIV treatment. AIDS Care, 16, 199–211.
Jensen-Fangel, S., Pedersen, L., Pedersen, C., Larsen, C. S, Tauris, P., Moller, A., et al. (2002). The effect of race/ethnicity on the outcome of highly active antiretroviral therapy for human immunodeficiency virus type 1–infected patients. Clinical Infectious Diseases, 35, 1541–1548.
Kelly, B., Raphael, B., Judd, F., Kernutt, G., Burnett, P., Dunne, M., et al. (1998). Posttraumatic stress disorder in response to HIV infection. General Hospital Psychiatry, 20, 345–352.
Kleeberger, C. A., Phair, J. P., Strathdee, S. A., Detels, R., Kingsley, L., & Jacobson, L. P. (2001). Determinants of heterogeneous adherence to HIV-antiretroviral therapies in the Multicenter AIDS cohort study. Journal of Acquired Immune Deficiency Syndrome, 26, 82–92.
Liu, H., Miller, L. G., Hays, R. D., Golin, C. E., Wu, T., Wenger, N. S., et al. (2006). Repeated measures longitudinal analyses of HIV virologic response as a function of percent adherence, dose timing, genotypic sensitivity, and other factors. Journal of Acquired Immune Deficiency Syndrome, 41, 315–322.
Mannheimer, S., Friedland, G., Matts, J., Child, C., & Chesney, M. (2002). The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus-infected persons in clinical trials. Clinical Infectious Diseases, 34, 1115–1121.
Molassiotis, A., Nahas-Lopez, V., Chung, R. W. Y., Lam, C. S. W., Li, P. C. K., & Lau, J. T. F. (2002). Factors associated with adherence to antiretroviral medication in HIV-infected patients. International Journal of STD & AIDS, 13, 301–310.
Murphy, D. A., Marelich, D., Hoffman, D., & Steers, W. N. (2004). Predictors of antiretroviral adherence. AIDS Care, 16, 471–484.
Murri, R., Ammassari, A., Gallicano, K., de Luca, A., Cingolani, A., Jacobson, D., et al. (2000). Patient-reported nonadherence to HAART is related to protease inhibitor levels. Journal of Acquired Immune Deficiency Syndrome, 24, 123–128.
Nieuwkerk, P. T., Sprangers, M. A. G., Burger, D. M., Hoetelmans, R. M. W., Hugen, P. W. H., Danner, S. A., et al. (2001). Limited patient adherence to highly active antiretroviral therapy for HIV-1 infection in an observational cohort study. Archives of Internal Medicine, 16, 1962–1968.
Nilsson Schönnesson, L., Diamond, P. M., Ross, M. W., Williams, M., & Bratt, G. (2006). Baseline predictors of three types of antiretroviral therapy (ART) adherence: A 2-year follow-up. AIDS Care, 18, 406–414.
Nilsson Schönnesson, L., Ross, M. W., & Williams, M. (2004). The HIV medication self-reported non-adherence reasons (SNAR) index and its underlying psychological dimensions. AIDS and Behavior, 8, 293–301.
Paterson, D. L., Swindells, S., Mohr, J., Brester, M., Vergis, E. N., Squier, C., et al. (2000). Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annual Internal Medicine, 133, 21–30.
Poppa, A., Davidson, D., Deutsch, J., Godfrey, D., Fisher, M., Head, S., et al. (2004). British HIV Association (BHIVA)/British Association for sexual health and HIV (N`BASHH) guidelines on provision of adherence support to individuals receiving antiretroviral therapy (2003). HIV Medicine, 5(Suppl. 2), S46–S60.
Simoni, J. M., Frick, P. A., Lockhart, D., & Liebovitz, D. (2002). Mediators of social support and antiretroviral adherence among an indigent population in New York City. AIDS Patient Care and STDs, 16, 431–429.
Singh, N., Squier, C., Sivek, M., Wagener, M., Nguyen, M. H., & Yu, V. L. (1996). Determinants of compliance with antiretroviral therapy in patients with human immunodefiency virus: Prospective assessment with implications for enhancing compliance. AIDS Care, 8, 261–269.
Stone, V. E., Hogam, J. W., Schuman, P., Rompalo, A. M., Howard, A. A., Korkontzelou, C., et al. (2001). Antiretroviral regimen complexity, self-reported adherence, and HIV-patients’ understanding of their regimens: Survey of women in the HER study. Journal of Acquired Immune Deficiency Syndrome, 28, 124–31.
Sundin, E. C., & Horowitz, M. J. (2002). Impact of event scale: Psychometric properties. British Journal of Psychiatry, 180, 205–209.
Turner, B. J. (2002). Adherence to antiretroviral therapy by human immunodeficiency virus-infected patients. Journal of Infectious Disease, 185(Suppl. 2), S143–S151.
Walsh, J. C., Horne, R., & Dalton, M. (2001). Reasons for non-adherence to antiretroviral therapy: Patients’ perspectives provide evidence of multiple causes. AIDS Care, 13, 709–720.
Acknowledgments
The authors would like to extend their gratitude to those women and men who participated in the study for their contribution and the nurses, in particular Eva-Lena Fredriksson, at Gay Men’s Health Center, Karolinska University Hospital—Söder Hospital, and Ing-Marie Johansson at the HIV Clinic, Karolinska University Hospital—Solna for administrating the questionnaires. This study is part of a longitudinal study that was supported by grants from the Swedish Foundation for Health Care Sciences and Allergy Research; Department of Research, Education, and Development, Stockholm City Council; the Magn Bergvall’s Foundation; the Swedish Physicians against AIDS Research Foundation, Sweden, and from the National Institute on Drug Abuse, USA, R03 DA 12328.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nilsson Schönnesson, L., Williams, M.L., Ross, M.W. et al. Factors Associated with Suboptimal Antiretroviral Therapy Adherence to Dose, Schedule, and Dietary Instructions. AIDS Behav 11, 175–183 (2007). https://doi.org/10.1007/s10461-006-9160-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-006-9160-0