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An update on the Barriers to Adherence and a Definition of Self-Report Non-adherence Given Advancements in Antiretroviral Therapy (ART)

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Abstract

Relying on the most frequently reported barriers to adherence and convenient definitions of non-adherence may lead to less valid results. We used a dominance analysis (a regression-based approach) to identify the most important barriers to adherence based on effect size using data collected through an online survey. The survey included the Adherence Barrier Questionnaire, self-reported non-adherence defined as a 4-day treatment interruption, and HIV clinical outcomes. The sample (N = 1217) was largely male, gay identified, and White. Nearly 1 in 3 participants reported “simply forgot” as a barrier; however, in a dominance analysis, it yielded a small effect size it its association with a 4-day treatment interruption. Further, dominance analyses stratified by race/ethnicity and age suggested that not all barriers impact all groups equally. The most frequently reported barriers to adherence were not the most important, and interventions should focus on barriers more strongly linked to clinical outcomes.

Resumen

Confiando en las barreras más frecuentemente reportadas a la adherencia y las definiciones convenientes de la no adherencia puede conducir a resultados menos válidos. Se utilizó un análisis de dominancia (un enfoque de regresión) para identificar las barreras más importantes a la adherencia basado en el tamaño del efecto utilizando datos recogidos a través de una encuesta en línea. La encuesta incluyó el Adherence Barrier Questionnaire, una auto-reporte de las definiciones de no adherencia como una interrupción del tratamiento de 4 días, y los resultados clínicos del VIH. La muestra (N = 1, 217) fue en gran parte varón, gay identificado, y blanco. Casi uno de cada tres participantes informó de la barrera “simplemente olvidó.” Sin embargo, en un análisis de dominancia, produjo un pequeño efecto de tamaño de su asociación con una interrupción del tratamiento de 4 días. Además, los análisis de dominancia estratificados por raza/etnia y edad sugieren que no todas las barreras afectan a todos los grupos por igual. Las barreras de adherencia más frecuentemente reportadas no fueron las más importantes, y las intervenciones deben centrarse en las barreras más fuertemente vinculadas a los resultados clínicos.

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Acknowledgments

We are grateful to all the individuals who took the time to participate in this study.

Funding

The first author completed the manuscript with support by grant R01 MH102198-S3 and T32 MH19105 from the National Institute of Mental Health (NIMH) of the U.S. Public Health Service. Support to the last author was provided by K23 MH097649 from the NIMH. Support to the second and third authors was provided by R01 MH102198 from the NIMH and K24 DA037034 from the National Institute of Drug Abuse.

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Authors and Affiliations

  1. Center for AIDS Prevention Studies, Department of Medicine, University of California - San Francisco, San Francisco, CA, USA

    John A. Sauceda, Torsten B. Neilands, Mallory O. Johnson & Parya Saberi

  2. Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, USA

    John A. Sauceda

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  1. John A. Sauceda
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  2. Torsten B. Neilands
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  3. Mallory O. Johnson
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  4. Parya Saberi
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Correspondence to John A. Sauceda.

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All authors declare they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards; as approved by the University of California, San Francisco’s Institutional Review Board.

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Informed consent was obtained from all individual participants included in the study.

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Sauceda, J.A., Neilands, T.B., Johnson, M.O. et al. An update on the Barriers to Adherence and a Definition of Self-Report Non-adherence Given Advancements in Antiretroviral Therapy (ART). AIDS Behav 22, 939–947 (2018). https://doi.org/10.1007/s10461-017-1759-9

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