Association of unmet needs for support services with medication use and adherence among HIV-infected individuals in the southeastern United States

Abstract

Unmet needs for services, such as housing and psychiatric treatment, are relatively common among HIV-infected individuals; however, the effects of different types of unmet needs on health-care outcomes are not well understood. This study describes unmet psychosocial needs and their relationship with health-care outcomes among individuals receiving HIV care in the southeastern US (n=526). We used multivariate logistic regression to examine the association of seven categories of unmet needs with HIV medication use and adherence. Most participants (84.5%) reported at least one service need in the past year. Nearly half (47%) of participants with service needs reported that at least one need was not met. Participants with one or more unmet needs were less likely to be taking any HIV medications (p = 0.007) and reported poorer medication adherence (p=0.013). The specific unmet needs for benefits (including Social Security, health insurance and prescription coverage) (p = 0.006) and a support group (p=0.040) were associated with being less likely to be taking any HIV medications. Unmet need for mental health-related counseling was associated with poorer medication adherence (p=0.003). Study findings regarding the high level of unmet need and the association of unmet need with poorer outcomes illustrate the importance of interventions to address these needs.

Acknowledgments

This analysis was supported by the Health Resources and Services Administration (HRSA) Grant # H76HA00614 of the US Department of Health and Human Services. The conclusions reached in this report are those of the authors and may not reflect the views of the funding agency. We thank Traci Dreher, Jeanette Johnson-Licon, Melinda Steele and Jai Uberoi for collecting patient consents and Dr. James Raper for his assistance with patient recruitment and Institutional Review Board approval. We also thank the clinicians and staff at each participating Infectious Diseases clinic for their assistance in obtaining Institutional Review Board approval, enrolling patients and for their general support of this research.