Risk Factors for Suboptimal Adherence Identified by Patient-Reported Outcomes Assessments in Routine HIV Care at 2 North American Clinics

Figures & data

Table 1 Demographic and Disease Characteristics of PWH Included in Chart Reviews (SMH and MSCC)

Parameter, n (%)	PWH (N=596)
Age, y
<30	68 (11)
30 to <40	117 (20)
40 to <50	109 (18)
50 to <60	135 (23)
≥60	165 (28)
Sex at birth
Male	409 (69)
Female	187 (31)
Race
Black	254 (43)
White	222 (37)
Asian	24 (4)
Other races/Not specified^a	86 (14)
Ethnicity
Hispanic	42 (7)
CD4+ cell count, cells/mm^3
≤350	107 (18)
351 to <500	101 (17)
≥500	388 (65)
Viral load
Undetectable	487 (82)
Detectable	109 (18)
Transmission risk category^b
Bisexual (either gender)	43 (7)
Blood product transfusion	17 (3)
Endemic area	54 (9)
Heterosexual	283 (47)
Injection drug user	31 (5)
Men who have sex with men	243 (41)
Unknown	19 (3)

Notes: ^aIncluding aboriginal, First Nations, Middle Eastern, mixed race, and Native American. ^bCategories are not mutually exclusive.

Abbreviations: MSCC, Midway Specialty Care Center; PWH, people with HIV; SMH, St Michael’s Hospital.

Table 2 Sociodemographic and Health-Related Characteristics of PWH Obtained from PROs (SMH and MSCC)

Variable	Category	Respondents, n (%)^a	PWH with Characteristic, n (%)^b
ART adherence	≥95%	1239 (76)	971 (78)
	<95%		268 (22)
	≥80%		1133 (91)
	<80%		106 (9)
HATQoL burden item^c	Satisfied	1527 (94)	1255 (82)
	Dissatisfied		272 (18)
HATQoL normal life item^d	Satisfied	1555 (95)	1312 (84)
	Dissatisfied		243 (16)
Combined HATQoL items	Satisfied	1580 (97)	1226 (78)
	Dissatisfied		354 (22)
Difficulty meeting housing costs	Yes	1539 (94)	978 (64)
	No		561 (36)
Depression	Moderate/Severe	1533 (94)	298 (19)
	Mild/None		1235 (81)
Intimate partner violence	Yes	1295 (79)	120 (9)
	No		1175 (91)
Risk of malnutrition	Yes	1608 (99)	365 (23)
	No		1243 (77)
Current smoker	Yes	1131 (69)	384 (34)
	No		747 (66)
Alcohol use	High risk	1620 (99)	311 (19)
	Low risk		1309 (81)
Substance use (past 3 months)	Yes	988 (61)	615 (62)
	No		373 (38)

Notes: ^aPercentage of the total number of PWH included in the analysis (N=1632). ^bPercentage of respondents for each variable. ^cIn the past 4 weeks, taking my [HIV] medicine has been a burden. ^dIn the past 4 weeks, taking my [HIV] medicine has made it hard to live a normal life.

Abbreviations: ART, antiretroviral therapy; HATQoL, HIV/AIDS-targeted quality of life; MSCC, Midway Specialty Care Center; PRO, patient-reported outcomes assessment; PWH, people with HIV; SMH, St Michael’s Hospital.

Table 3 Unadjusted Odds Ratios for Association with <95% and <80% Adherence to ART Among PWH (N=1239; SMH and MSCC)

Variable	Category	<95% Adherence		<80% Adherence
		Unadjusted OR (95% CI)	P value^a	Unadjusted OR (95% CI)	P value^a
HATQoL burden item^b	Dissatisfied (vs satisfied)	4.322 (3.141–5.947)	<0.0001	5.245 (3.451–7.970)	<0.0001
HATQoL normal life item^c	Dissatisfied (vs satisfied)	2.639 (1.873–3.719)	<0.0001	3.663 (2.358–5.691)	<0.0001
Combined HATQoL items	Dissatisfied (vs satisfied)	3.384 (2.510–4.561)	<0.0001	4.258 (2.824–6.420)	<0.0001
Difficulty meeting housing costs	No (vs yes)	0.669 (0.494–0.906)	0.0093	0.714 (0.455–1.119)	0.1418
Depression	Mild/None (vs moderate/ severe)	0.547 (0.394–0.759)	0.0003	0.638 (0.397–1.024)	0.0629
Intimate partner violence	No (vs yes)	0.642 (0.404–1.023)	0.0623	0.599 (0.313–1.145)	0.1207
Risk of malnutrition	No (vs yes)	0.582 (0.425–0.797)	0.0007	0.610 (0.390–0.956)	0.0309
Current smoker	No (vs yes)	0.675 (0.487–0.937)	0.0188	0.579 (0.355–0.947)	0.0295
Alcohol use	Low risk (vs high risk)	1.254 (0.878–1.792)	0.2135	1.297 (0.757–2.223)	0.3442
Substance use (past 3 months)	No (vs yes)	1.120 (0.781–1.604)	0.5385	1.058 (0.595–1.882)	0.8470

Notes: ^aBold values denote P values <0.05. ^bIn the past 4 weeks, taking my [HIV] medicine has been a burden. ^cIn the past 4 weeks, taking my [HIV] medicine has made it hard to live a normal life.

Abbreviations: ART, antiretroviral therapy; CI, confidence interval; HATQoL, HIV/AIDS-targeted quality of life; MSCC, Midway Specialty Care Center; OR, odds ratio; PWH, people with HIV; SMH, St Michael’s Hospital.

Table 4 Adjusted Odds Ratios from Multivariate Logistic Regression Models for Association with <95% Adherence to ART Among PWH (SMH and MSCC)

Variable	Category	Before Multiple Imputation^a		After Multiple Imputation^b
		Adjusted OR (95% CI)	P value^c	Adjusted OR (95% CI)	P value^c
Model 1: HATQoL burden item
HATQoL burden item^d	Dissatisfied (vs satisfied)	3.357 (2.263–4.979)	<0.0001	3.795 (2.725–5.285)	<0.0001
Difficulty meeting housing costs	No (vs yes)	0.880 (0.608–1.273)	0.4974	0.902 (0.652–1.249)	0.5357
Depression	Mild/None (vs moderate/severe)	0.875 (0.582–1.317)	0.5226	0.798 (0.553–1.152)	0.2284
Intimate partner violence	No (vs yes)	0.678 (0.398–1.157)	0.1542	0.777 (0.473–1.276)	0.3181
Risk of malnutrition	No (vs yes)	0.704 (0.476–1.042)	0.0792	0.724 (0.516–1.015)	0.0613
Model 2: HATQoL normal life item
HATQoL normal life item^e	Dissatisfied (vs satisfied)	2.286 (1.487–3.516)	0.0002	2.248 (1.566–3.228)	<0.0001
Difficulty meeting housing costs	No (vs yes)	0.808 (0.561–1.165)	0.2536	0.832 (0.605–1.145)	0.2587
Depression	Mild/None (vs moderate/severe)	0.759 (0.509–1.131)	0.1757	0.745 (0.519–1.070)	0.1113
Intimate partner violence	No (vs yes)	0.818 (0.481–1.391)	0.4575	0.860 (0.525–1.407)	0.5471
Risk of malnutrition	No (vs yes)	0.711 (0.484–1.046)	0.0836	0.705 (0.506–0.980)	0.0377
Model 3: Combined HATQoL items
Combined HATQoL items	Dissatisfied (vs satisfied)	2.762 (1.905–4.004)	<0.0001	3.020 (2.207–4.132)	<0.0001
Difficulty meeting housing costs	No (vs yes)	0.871 (0.604–1.255)	0.4571	0.889 (0.642–1.230)	0.4771
Depression	Mild/None (vs moderate/severe)	0.804 (0.538–1.200)	0.2856	0.798 (0.553–1.150)	0.2259
Intimate partner violence	No (vs yes)	0.779 (0.459–1.323)	0.3557	0.858 (0.524–1.404)	0.5418
Risk of malnutrition	No (vs yes)	0.730 (0.495–1.077)	0.1126	0.714 (0.511–0.997)	0.0481

Notes: ^aN=950, N=951, and N=961 in models 1, 2, and 3, respectively. ^bN=1239 in each model. ^cBold values denote P values <0.05. ^dIn the past 4 weeks, taking my [HIV] medicine has been a burden. ^eIn the past 4 weeks, taking my [HIV] medicine has made it hard to live a normal life.

Abbreviations: ART, antiretroviral therapy; CI, confidence interval; HATQoL, HIV/AIDS-targeted quality of life; MSCC, Midway Specialty Care Center; OR, odds ratio; PWH, people with HIV; SMH, St Michael’s Hospital.

Table 5 Adjusted Odds Ratios from Multivariate Logistic Regression Models for Association with <80% Adherence to ART Among PWH (SMH and MSCC)

Variable	Category	Before Multiple Imputation^a		After Multiple Imputation^b
		Adjusted OR (95% CI)	P value^c	Adjusted OR (95% CI)	P value^c
Model 1: HATQoL burden item
HATQoL burden item^d	Dissatisfied (vs satisfied)	3.832 (2.250–6.526)	<0.0001	5.005 (3.219–7.783)	<0.0001
Difficulty meeting housing costs	No (vs yes)	0.944 (0.537–1.660)	0.8422	1.071 (0.657–1.747)	0.7820
Depression	Mild/None (vs moderate/severe)	0.892 (0.498–1.597)	0.7015	1.003 (0.590–1.705)	0.9909
Intimate partner violence	No (vs yes)	0.678 (0.321–1.428)	0.3064	0.744 (0.379–1.458)	0.3883
Risk of malnutrition	No (vs yes)	0.696 (0.399–1.212)	0.2002	0.764 (0.472–1.237)	0.2734
Model 2: HATQoL normal life item
HATQoL normal life item^e	Dissatisfied (vs satisfied)	3.118 (1.761–5.521)	<0.0001	3.290 (2.052–5.275)	<0.0001
Difficulty meeting housing costs	No (vs yes)	0.895 (0.511–1.568)	0.6993	0.971 (0.599–1.573)	0.9052
Depression	Mild/None (vs moderate/severe)	0.870 (0.485–1.560)	0.6397	0.949 (0.560–1.606)	0.8447
Intimate partner violence	No (vs yes)	0.763 (0.365–1.595)	0.4723	0.859 (0.442–1.669)	0.6534
Risk of malnutrition	No (vs yes)	0.698 (0.402–1.211)	0.2009	0.740 (0.461–1.188)	0.2122
Model 3: Combined HATQoL items
Combined HATQoL items	Dissatisfied (vs satisfied)	3.278 (1.945–5.524)	<0.0001	4.018 (2.599–6.211)	<0.0001
Difficulty meeting housing costs	No (vs yes)	0.915 (0.522–1.606)	0.7572	1.045 (0.642–1.701)	0.8596
Depression	Mild/None (vs moderate/severe)	0.908 (0.507–1.626)	0.7445	0.998 (0.589–1.690)	0.9926
Intimate partner violence	No (vs yes)	0.763 (0.364–1.601)	0.4748	0.840 (0.432–1.632)	0.6059
Risk of malnutrition	No (vs yes)	0.688 (0.396–1.195)	0.1847	0.742 (0.461–1.195)	0.2201

Notes: ^aN=950, N=951, and N=961 in models 1, 2, and 3, respectively. ^bN=1239 in each model. ^cBold values denote P values <0.05. ^dIn the past 4 weeks, taking my [HIV] medicine has been a burden. ^eIn the past 4 weeks, taking my [HIV] medicine has made it hard to live a normal life.

Abbreviations: ART, antiretroviral therapy; CI, confidence interval; HATQoL, HIV/AIDS-targeted quality of life; MSCC, Midway Specialty Care Center; OR, odds ratio; PWH, people with HIV; SMH, St Michael’s Hospital.

Table 6 Adjusted Odds Ratios from Multivariate Stepwise Selection Logistic Regression Models for Association with <95% Adherence to ART Among PWH (SMH and MSCC)

Variable	Category	Before Multiple Imputation^a		After Multiple Imputation^b
		Adjusted OR (95% CI)	P value^c	Adjusted OR (95% CI)	P value^c
Model 1: HATQoL burden item
HATQoL burden item^d	Dissatisfied (vs satisfied)	4.056 (2.937–5.602)	<0.0001	4.045 (2.933–5.579)	<0.0001
Risk of malnutrition	No (vs yes)	0.656 (0.471–0.913)	0.0125	0.677 (0.487–0.940)	0.0198
Model 2: HATQoL normal life item
HATQoL normal life item^e	Dissatisfied (vs satisfied)	2.413 (1.701–3.423)	<0.0001	2.530 (1.790–3.577)	<0.0001
Risk of malnutrition	No (vs yes)	0.660 (0.477–0.914)	0.0124	0.655 (0.475–0.904)	0.0100
Model 3: Combined HATQoL items
Combined HATQoL items	Dissatisfied (vs satisfied)	3.181 (2.351–4.304)	<0.0001	3.255 (2.406–4.404)	<0.0001
Risk of malnutrition	No (vs yes)	0.671 (0.484–0.929)	0.0164	0.672 (0.486–0.931)	0.0167

Notes: ^aN=1206, N=1208, and N=1225 in models 1, 2, and 3, respectively. ^bN=1239 in each model. ^cBold values denote P values <0.05. ^dIn the past 4 weeks, taking my [HIV] medicine has been a burden. ^eIn the past 4 weeks, taking my [HIV] medicine has made it hard to live a normal life.

Abbreviations: ART, antiretroviral therapy; CI, confidence interval; HATQoL, HIV/AIDS-targeted quality of life; MSCC, Midway Specialty Care Center; OR, odds ratio; PWH, people with HIV; SMH, St Michael’s Hospital.