Abstract
Medical care for HIV disease may be most effective when medical surveillance and services are initiated early and consistently maintained over time. To benefit from continually improving HIV care regimens, persons living with HIV/AIDS must first adhere to their outpatient medical appointments. The purpose of this study was to examine psychosocial, illness, and demographic factors associated with appointment adherence problems early in HIV treatment. Results indicated that nonadherence to outpatient medical appointments was a significant problem. One hundred forty-four patients were followed for 6 months after their initial appointment at a public HIV clinic. One in five dropped out of treatment before completing their intake assessment (separate nurse and physician appointments). Men and individuals with lower levels of social support were most likely to drop out before seeing a physician. Emotional distress was not associated with early dropout, but elevated levels of anxiety and depression were found across the sample. Those still attending the clinic (n = 114) were then followed for 12 months after clinic enrollment. Overall, 35% of scheduled medical appointments were missed during this period. Higher baseline CD4 counts and injection drug use history were predictive of poor appointment adherence, but other demographic and psychosocial indices were not. These findings suggest increased research and early intervention efforts are needed to improve appointment adherence among persons living with HIV/AIDS.
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REFERENCES
Agras, S. (1989). Understanding compliance to the medical regimen: The scope of the problem and a theoretical perspective. Arthritis Care and Research, 2, S2–S7.
Ayres, A., Hoon, P., Franzoni, J., Matheny, K., Contanch, P., and Takayanagi, S. (1994). Influence of mood and adjustment to cancer on compliance to chemotherapy among breast cancer patients. Journal of Psychosomatic Research, 38, 393–402.
Bangsberg, D., Robertson, M., Charlebois, E., Tulsky, J., Hecht, F. M., Bamberger, J., and Moss, A. R. (1998, July). Protease inhibitors (PI) in the HIV+ homeless and marginally housed (H/M): Good adherence but rarely prescribed. Paper presented at the meeting of the 12th World AIDS Conference, Geneva, Switzerland.
Becker, M. H. (1985). Patient adherence to prescribed therapies. Medical Care, 23, 539–555.
Blackwell, B. (1992). Compliance. Psychotherapy and Psychosomatics, 58, 161–169.
Blaschke, T. F. (1997, January). Noncompliance and resistance to protease inhibitors. Paper presented at the 4th Conference on Retroviruses and Opportunistic Infections, Washington, D.C.
Boyer, C., Friend, R., Chlouverakis, G., and Kaloyanides, G. (1990). Social support and demographic factors influencing compliance of hemodialysis patients. Journal of Applied Social Psychology, 20, 1902–1918.
Broers, B., Morabia, A., and Hirschel, B. (1994). A cohort study of drug users' compliance with zidovudine treatment. Archives of Internal Medicine, 154, 1121–1127.
Carney, R., Freedland, K., Eisen, S., Rich, M., and Jaffe, A. (1995). Major depression and medication adherence in elderly patients with coronary artery disease. Health Psychology, 14, 88–90.
Carpenter, C. C. J., Fischl, M. A., Hammer, S. M., Hirsch, M. S., Jacobsen, D. M., Katzenstein, D. A., Montaner, J. S. G., Richman, D. D., Saag, M. S., Schooley, R. T., Thompson, M. A., Vella, S., Yeni, P. G., and Volberding, P. A. (1998). Antiretroviral therapy for HIV infection in 1998: Updated recommendations of the International AIDS Society—USA panel. Journal of the American Medical Association, 280, 78–86.
Cohen, J., and Cohen, P. (1983). Applied multiple regression/correlation analysis for the behavioral sciences, 2nd ed. Hillsdale, NJ: Erlbaum.
Cohen, S., Mermelstein, R., Kamarck, T., and Hoberman, H. (1985). Measuring the functional components of social support. In I. G. Sarason and B. R. Sarason (Eds.), Social support: Theory, research, and application (pp. 73–94). The Hague: Martinus Nijhonff.
DiMatteo, M., and DiNicola, D. D. (1982). Achieving patient compliance. New York: Pergamon Press.
Dunbar-Jacob, J., Burke, L. E., and Puczynski, S. (1995). Clinical assessment and management of adherence to medical regimens. In P. M. Nicassio and T. W. Smith (Eds.), Managing chronic illness: A biopsychosocial perspective (pp. 313–349). Washington, DC: American Psychological Association.
Eldred, L. J. (in press). Outcome research: Adherence in the era of protease inhibitors. AIDS.
Eldred, L. J., Wu., A. W., Chaisson, R. E., and Moore, R. E. (1998). Adherence to antiretroviral and Pneumocystis prophylaxis in HIV disease. Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, 18, 117–125.
Gallant, J. E., and Block, D. S. (1998). Adherence to antiretroviral regimens in HIV-infected patients: Results of a survey among physicians and patients. Journal of the International Association of Physicians in AIDS Care, 4, 32–35.
German, P. (1988). Compliance and chronic disease. Hypertension, 11, 56–60.
Gorman, J., Kertzner, R., Cooper, T., Goetz, R., Lagomasino, I., Novacenko, H., Williams, J., Stern, Y., Mayeux, R., and Ehrhardt, A. (1991). Glucocorticoid level and neuropsychiatric symptoms in homosexual men with HIV infection. American Journal of Psychiatry, 148, 41–45.
Griffin, K. W., and Rabkin, J. G. (1997). Psychological distress in people with HIV/AIDS: Prevalence rates and methodological issues. AIDS and Behavior, 1, 29–42.
Hecht, F., Colfax, G., Swanson, M., and Chesney, M. A. (1998, February). Adherence and effectiveness of protease inhibitors in clinical practice. In: Program and Abstracts of the 5th Conference on Retroviruses and Opportunistic Infections, Abstract 151, Session 24, Chicago, Illinois.
Ickovics, J. R., and Meisler, A. W. (1997). Adherence in AIDS clinical trials: A framework for clinical research and clinical care. Journal of Clinical Epidemiology, 50, 385–391.
Kalichman, S. C., and Sikkema, K. J. (1994). Psychological sequelae of HIV infection and AIDS: Review of empirical findings. Clinical Psychology Review, 14, 611–632.
Kelly, J., Murphy, D., Bahr, G., Koob, J., Morgan, M., Kalichman, S., Stevenson, L., Brasfield, T., Bernstein, B., and St. Lawrence, J. (1993). Factors associated with severity of depression and high-risk sexual behavior among persons diagnosed with human immunodeficiency virus (HIV) infection. Health Psychology, 12, 215–219.
Kissinger, P., Cohen, D., Brandon, W., Rice, J., Morse, A., and Clark, R. (1995). Compliance with public sector HIV medical care. Journal of the National Medical Association, 87, 19–24.
Lopez-Suarez, A., Fernandez-Gutierrez, C., Perez-Guzman, E., and Giron-Gonzalez, J. A. (1998). Adherence to the antiretroviral treatment in asymptomatic HIV-infected patients [Letter]. AIDS, 12, 685–686.
McClure, J. B., Catz, S. L., Davis, P. G., Brantley, P. J., and Jones, G. N. (1995). Predictors of medical utilization in HIV+ patients: Psychosocial and illness factors. Annals of Behavioral Medicine, 17 (Supplement), 181.
McClure, J. B., Catz, S. L., Prejean, J., Brantley, P. J., and Jones, G. N. (1996). Factors associated with depression in a heterogeneous HIV-infected sample. Journal of Psychosomatic Research, 40, 407–415.
Muma, R. D., Ross, M. W., Parcel, G. S., and Pollard, R. B. (1995). Zidovudine adherence among individuals with HIV infection. AIDS Care, 7, 439–447.
Podell, R. N. (1975). Physician's guide to compliance in hypertension. West Point, PA: Merck and Co.
Radloff, L. S. (1977). The CES-D Scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.
Richman, D. D. (1996). New strategies to combat HIV drug resistance. Hospital Practice, 15, 47–58.
Rosenstock, I. M. (1975). Patients' compliance with health regimens. Journal of the American Medical Association, 234, 402–403.
Sackett, D. L., and Snow, J. C. (1979). The magnitude of compliance and noncompliance. In R. B. Haynes, D. W. Taylor, and D. L. Sackett (Eds.), Compliance in health care (pp. 9–25). Baltimore: Johns Hopkins Press.
Shelton, D., Marconi, K., Pounds, M., Scopetta, M., O'Sullivan, M. J., and Szapocznik, J. (1993). Medical adherence among prenatal, HIV seropositive, African-American women: Family issues. Family Systems Medicine, 11, 343–356.
Sherbourne, C. D., Hays, R. D., Ordway, L., DiMatteo, M. R., and Kravitz, R. L. (1992). Antecedents of adherence to medical recommendations: Results from the medical outcomes study. Journal of Behavioral Medicine, 15, 447–468.
Singh, N., Squier, C., Sivek, C., Wagener, M., Hong Nguyen, M., and Yu, V. L. (1996). Determinants of compliance with antiretroviral therapy in patients with human immunodeficiency virus: Prospective assessment with implications for enhancing compliance. AIDS Care, 8, 261–269.
Smith, M. Y., Rapkin, B. D., Morrison, A., and Kammerman, S. (1997). Zidovudine adherence in person with AIDS. Journal of General Internal Medicine, 12, 216–223.
Speilberger, C. (1983). Manual of the state-trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press.
Turner, J. G., Nokes, K. M., Corless, I. B., Holzemer, W. L., Inouye, J., Brown, M. A., and Powell-Cope, G. M. (1998). History of drug use and adherence in HIV+ persons. Paper presented at the meeting of the 12th World AIDS Conference, Geneva, Switzerland.
Tracy, H. M., Green, C., and McCleary, J. (1987). Noncompliance in hemodialysis patients as measured with the MBHI. Psychology and Health, 1, 411–423.
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McClure, J.B., Catz, S.L. & Brantley, P.J. Early Appointment Adherence Among Persons Living with HIV. AIDS Behav 3, 157–165 (1999). https://doi.org/10.1023/A:1025492108281
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DOI: https://doi.org/10.1023/A:1025492108281