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Abstract
This paper examines factors associated with adherence to antiretroviral medications (ARVs) in an HIV-infected population at high risk for non-adherence: individuals living with psychiatric and substance abuse disorders. Data were examined from baseline interviews of a multisite cohort intervention study of 1138 HIV-infected adults with both a psychiatric and substance abuse disorder (based on a structured psychiatric research interview using DSM-IV criteria). The baseline interview documented mental illness and substance use in the past year, mental illness and substance abuse severity, demographics, service utilization in the past three months, general health and HIV-related conditions, self-reported spirituality and self-reported ARV medication use. Among the participants, 62% were prescribed ARVs at baseline (n = 542) and 45% of those on ARVs reported skipping medications in the past three days. Reports of non-adherence were significantly associated with having a detectable viral load (p<.01). The factors associated with non-adherence were current drug and alcohol abuse, increased psychological distress, less attendance at medical appointments, non-adherence to psychiatric medications and lower self-reported spirituality. Increased psychological distress was significantly associated with non-adherence, independent of substance abuse (p<.05). The data suggest that both mental illness and substance use must be addressed in HIV-infected adults living with these co-morbid illnesses to improve adherence to ARVs.
Acknowledgements
This work was supported by a cooperative agreement for the HIV/AIDS Treatment Adherence, Health Outcomes and Cost Study, a collaboration of six federal entities within the Department of Health and Human Services (DHHS): The Center for Mental Health Services (CMHS), which has the lead administrative responsibility, and the Center for Substance Abuse Treatment (CSAT), both components of the SAMHSA; the HIV/AIDS Bureau of the HRSA; and the National Institute of Mental health (NIMH), the National Institute on Drug Abuse (NIDA) and the National Institute on Alcohol Abuse and Alcoholism (NIAAA), all parts of the NIH.
Notes
1. The presence of anxiety disorders is most likely underestimated due to skip out patterns on our version of the SCID. If criteria for depression were met, questions on generalized anxiety disorder were not asked given the difficulty of differential diagnosis when only a year time frame is used.