Use of and Adherence to Antiretroviral Therapy in a Large U.S. Sample of HIV-infected Adults in Care, 2007-2008
Linda Beer*, 1, James Heffelfinger1, Emma Frazier1, Christine Mattson1, Brad Roter2, Elizabeth Barash3, Susan Buskin3, 4, Todd Rime5, Eduardo Valverde1
1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for
Disease Control and Prevention, Atlanta, Georgia, USA
2 Country Doctor Community Health Centers and University of Washington School of Medicine, Seattle, Washington,
3 Public Health - Seattle & King County, Seattle, Washington, USA and University of Washington, Seattle, Washington,
4 University of Washington, Seattle, Washington, USA
5 Washington State Department of Health, Olympia, Washington, USA
Antiretroviral therapy (ART) is the cornerstone of HIV clinical care and is increasingly recognized as a key component of HIV prevention. However, the benefits of ART can be realized only if HIV-infected persons maintain high levels of adherence.
We present interview data (collected from June 2007 through September 2008) from a national HIV surveillance system in the United States—the Medical Monitoring Project (MMP)—to describe persons taking ART. We used multivariate logistic regression to assess behavioral, sociodemographic, and medication regimen factors associated with three measures that capture different dimensions of nonadherence to ART: dose, schedule, and instruction.
The use of ART among HIV-infected adults in care was high (85%), but adherence to ART was suboptimal and varied across the three measures of nonadherence. Of MMP participants currently taking ART, the following reported nonadherence during the past 48 hours: 13% to dose, 27% to schedule, and 30% to instruction. The determinants of the three measures also varied, although younger age and binge drinking were associated with all aspects of nonadherence.
Our results support the measurement of multiple dimensions of medication-taking behavior in order to avoid overestimating adherence to ART.
Keywords:: HIV, medication adherence, antiretroviral therapy, Centers for Disease Control and Prevention (U.S.)..
open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.
* Address correspondence to this author at the Division of HIV/AIDS
Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB
Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia,
USA; Tel: 404-639-5268; Fax: 404-639-8640; E-mail: Lbeer@cdc.gov