Abstract
Background
Reasons for and frequency of nonadherence to antiretroviral therapy (ART) may have changed due to pharmacological improvements. In addition, the importance of known non-pharmacologic reasons for nonadherence is unclear.
Methods
We performed a cross-sectional, noninterventional, multicenter study to identify current reasons for nonadherence. Patients were categorized by physicians into the following adherence groups: good, unstable, or poor adherence. Co-variables of interest included age, sex, time since HIV diagnosis, ART duration, current ART regimen, HIV transmission route, comorbidity, HIV-1 RNA viral load (VL), and CD4 cell count. Patients self-reported the number of missed doses and provided their specific reasons for nonadherent behavior. Statistical analyses were performed using Fisher’s extended exact test, Kruskal–Wallis test, and logistic regression models.
Results
Our study assessed 215 participants with good (n=162), unstable (n=36), and poor adherence (n=17). Compared to patients with good adherence, patients with unstable and poor adherence reported more often to have missed at least one dose during the last week (good 11% vs unstable 47% vs poor 63%, p<0.001). Physicians’ adherence assessment was concordant with patients’ self-reports of missed doses during the last week (no vs one or more) in 81% cases. Similarly, we found a strong association of physicians’ assessment with viral suppression. Logistic regression analysis showed that “reduced adherence” – defined as unstable or poor – was significantly associated with patients <30 years old, intravenous drug use, history of acquired immune deficiency syndrome (AIDS), and psychiatric disorders (p<0.05). Univariate analyses showed that specific reasons, such as questioning the efficacy/dosing of ART, HIV stigma, interactive toxicity beliefs regarding alcohol and/or party drugs, and dissatisfaction with regimen complexity, correlated with unstable or poor adherence (p<0.05).
Conclusion
Identification of factors associated with poor adherence helps in identifying patients with a higher risk for nonadherence. Reasons for nonadherence should be directly addressed in every patient, because they are common and constitute possible adherence intervention points.
Acknowledgments
The authors would like to express their gratitude to all respondents who participated in the study. This work was supported by the German Research Foundation (DFG) and the Technical University of Munich. Part of this work was presented at HIV Drug Therapy Glasgow 2016, October 23, 2016, to October 26, 2016, UK, P060. We would like to acknowledge the Department of Medicine II, University Hospital Klinikum rechts der Isar, MVZ Karlsplatz, HIV Clinical Care Center, Center of Infectiology Prenzlauer Berg, Private Practice, Zentrum fuer Innere Medizin und Infektiologie, Private Practice, and Department of Dermatology and Allergology, University Hospital Klinikum rechts der Isar, for participating and recruiting patients for the study. The contributions of MUC Research in the support of statistical analyses are also very gratefully acknowledged. The datasets used and analyzed during the current study are available upon reasonable request to the corresponding author Johanna Boretzki.
Author contributions
CDS, CW, AB, and EW developed the study design and used the questionnaires. CDS, CW, AM, IK, AZ, SN, and JB recruited the patients for the study and performed the questionnaires. AB, EW, and JB conducted the statistical analyses of the data and interpreted the results together with CDS, CW, and CL. CDS, EW, AB, SN, and JB were the major contributors in writing the manuscript. All authors contributed toward data analysis, drafting and critically revising the paper and agree to be accountable for all aspects of the work. All the authors read and approved the final version of the manuscript.
Disclosure
CW received travel grants from AbbVie, Bristol-Meyers Squibb, Gilead Science, and Jansen. AZ received travel grants from AbbVie, Bristol-Meyers Squibb, Gilead Sciences, and MSD. IK received travel grants from ViiV, Abbvie, MDS, Gilead, and Bristol-Meyers Squibb. The other authors report no conflicts of interest in this work.