Factors associated with adherence to highly active antiretroviral therapy in homeless or unstably housed adults living with HIV

Abstract

The aim of this study is to investigate adherence to highly active antiretroviral therapy (HAART) in persons living with HIV/AIDS (PLWHA) who are homeless or unstably housed. We evaluated homeless or unstably housed PLWHA (n=644) in three US cities were enrolled in the Housing and Health Study. Using baseline data and controlling for gender, race, age, and education, we examined associations between self-reported two- and Seven-day adherence and access to healthcare, mental health, substance use, and attitudes toward HIV medical therapy. Of the 644 participants, 358 (55%) were currently on HAART. For two-day adherence, 280 (78%) reported missing no prescribed doses (100% adherence), and for seven-day adherence, 291 (81%) reported ≥90% adherence. Logistic regression analyses indicated being younger, not having health insurance, and drug use were associated with missing ≥1 dose over the past two days. Scoring lower on SF-36 mental component summary scale and having greater risk of depression (CES-D) and stress (Perceived Stress Scale) were associated with poorer adherence for both two- and seven-day outcomes. Negative attitudes toward HIV treatment were also associated with lower adherence. Adherence to HIV medications in this population is similar to other groups. Coexisting problems of access to healthcare, higher risk of mental health problems, along with poorer attitudes toward treatment are associated with increased likelihood of missing doses. Comprehensive models of HIV care that include a continuum of medical and social services are essential for treating this population.

Keywords:

• homeless
• HAART
• adherence
• HIV
• mental health
• substance use

Acknowledgements

We would like to thank the many people who made this study a success. In addition to the authors of this paper, the Housing and Health Study members (in alphabetical order) include Arturo Bendixen (AIDS Foundation of Chicago), Kate Briddell (City of Baltimore, Department of Housing and Community Development), Cari Courtenay-Quirk (CDC), Shahry Deyhimy (City of Los Angeles Housing Department), Paul Dornan (HUD), David Harre (formerly with HUD), Myrna Hooper (Housing Authority of the City of Los Angeles), Jennafer Kwait (RTI), Fred Licari (RTI), Shirley Nash (City of Chicago Department of Public Health), Sherri Pals (CDC) William Rudy (HUD), Esther Sumartojo (CDC), and David Vos (HUD). We would also like to acknowledge the contributions of Rusty Bennett, Maria Caban, Sylvia Cohn, Lynne Cooper, Jay Cross, Maria DiGregorio, Clyde Hart, Kirk Henny, Joyce Moon Howard, Kelly Kent, Lee Lam, Cristofer Price, Noelle Richa, Danny Ringer, Randy Russell, Ruth Schwartz, and Tom Spir. Portions of this paper were presented at the XVI International AIDS Conference, Toronto, Canada, August 2006. Funding for the research study was provided by the Centers for Disease Control and Prevention to RTI under contract 200-2001-0123, Task 9 and funding for permanent supportive housing rental assistance was provided by the Department of Housing and Urban Development.

Notes

The findings and conclusions in this paper are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.