Determinants of HAART discontinuation among injection drug users

Abstract

The objective of this study was to identify psychosocial determinants of, and self-reported reasons for, HAART discontinuation among HIV-positive injection drug users (IDUs). We examined correlates between sociodemographic characteristics, drug use and risk behaviors, outcome expectations, adherence self-efficacy, social support and HAART discontinuation among 160 HIV-positive participants in the Vancouver Injection Drug Users’ Study (VIDUS). Logistic regression was used to identify the factors independently associated with discontinuation of HAART. Seventy-one (44%) study participants discontinued HAART during the study period. Factors independently associated with discontinuation of HAART included recent incarceration (OR = 4.84, p=0.022), negative outcome expectations (OR = 1.41, p=0.001), adherence efficacy expectations (OR = 0.70, p=0.003) and self-regulatory efficacy (OR = 0.86, p=0.050). The most frequently cited reasons provided for discontinuing HAART were being in jail (44%) and medication side effects (41%). The results of this study suggest that psychological constructs derived from self-efficacy theory are highly germane to the understanding of HAART discontinuation behavior and interventions that may change it. Incarceration may result in interruptions in HAART among IDUs, and programmatic changes may be needed to promote optimal retention on HAART among incarcerated HIV-infected IDUs.

Acknowledgments

The authors wish to thank all of the participants of the VIDUS project. Thomas Kerr's work on this study was supported through a Canadian Institutes for Health Research Doctoral Training Award. Anita Palepu is supported by a Canadian Institute of Health Research New Investigator Award. Evan Wood is supported by the Michael Smith Foundation for Health Research. Robert Hogg is supported by the Michael Smith Foundation for Health Research through a Career Investigator Award and by Canadian Institutes of Health Research through an Investigator Award. We also thank Benita Yip, Kathy Li, Bonnie Devlin, John Charette, Will Small, Kathy Churchill, Caitlin Johnston, Robin Brooks, Steve Kain, Peter Vann and Nancy Laliberte for their research and administrative assistance.