Barriers to antiretroviral therapy adherence and plasma HIV RNA suppression among AIDS clinical trials group study participants.

TitleBarriers to antiretroviral therapy adherence and plasma HIV RNA suppression among AIDS clinical trials group study participants.
Publication TypeJournal Article
Year of Publication2015
AuthorsSaberi P, Neilands TB, Vittinghoff E, Johnson MO, Chesney M, Cohn SE
JournalAIDS Patient Care STDS
Volume29
Issue3
Pagination111-6
Date Published2015 Mar
ISSN1557-7449
KeywordsAdult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, Clinical Trials as Topic, Female, HIV Infections, HIV-1, Humans, Longitudinal Studies, Male, Medication Adherence, Middle Aged, RNA, Viral, Treatment Outcome
Abstract

We conducted a secondary data analysis of 11 AIDS Clinical Trials Group (ACTG) studies to examine longitudinal associations between 14 self-reported antiretroviral therapy (ART) adherence barriers (at 12 weeks) and plasma HIV RNA (at 24 weeks) and to discern the relative importance of these barriers in explaining virologic detectability. Studies enrolled from 1997 to 2003 and concluded between 2002 and 2012. We included 1496 (54.2% of the original sample) with complete data. The most commonly selected barriers were "away from home" (21.9%), "simply forgot" (19.6%), "change in daily routine" (19.5%), and "fell asleep/slept through dosing time" (18.9%). In bivariate analyses, "too many pills to take" (OR=0.43, p<0.001), "wanted to avoid side effects" (OR=0.54, p=0.001), "felt drug was toxic/harmful" (OR=0.44, p<0.001), "felt sick or ill" (OR=0.49, p<0.001), "felt depressed/overwhelmed" (OR=0.58, p=0.004), and "problem taking pills at specified time" (OR=0.71, p=0.04) were associated with a lower odds of an undetectable HIV RNA. "Too many pills to take," "wanted to avoid side effects," "felt drug was toxic/harmful," "felt sick/ill,", and "felt depressed/overwhelmed" had the highest relative importance in explaining virologic detectability. "Simply forgot" was not associated with HIV RNA (OR=0.99, p=0.95) and was ninth in its relative importance. Adherence interventions should prioritize barriers with highest importance in explaining virologic outcomes rather than focusing on more commonly reported barriers.

DOI10.1089/apc.2014.0255
Alternate JournalAIDS Patient Care STDS
PubMed ID25615029
PubMed Central IDPMC4352694
Grant ListK23 MH097649 / MH / NIMH NIH HHS / United States
K23MH097649 / MH / NIMH NIH HHS / United States
K24MH087220 / MH / NIMH NIH HHS / United States
P30 MH062246 / MH / NIMH NIH HHS / United States
U01 AI69471 / AI / NIAID NIH HHS / United States
U01AI068636 / AI / NIAID NIH HHS / United States
UM1 AI068636 / AI / NIAID NIH HHS / United States
UM1 AI069471 / AI / NIAID NIH HHS / United States