HIV/AIDS: Research and Palliative Care (May 2021)
Evaluation of the Sociodemographic, Behavioral and Clinical Influences on Complete Antiretroviral Therapy Adherence Among HIV-Infected Adults Receiving Medical Care in Houston, Texas
Abstract
Pagna Sok,1,2 Osaro Mgbere,3,4 Lisa Pompeii,1,2 Ekere James Essien1,4,5 1The University of Texas School of Public Health, Texas Medical Center, Houston, TX, USA; 2Department of Pediatrics, Baylor College of Medicine, Texas Medical Center, Houston, TX, USA; 3Disease Prevention and Control Division, Houston Health Department, Houston, TX, USA; 4Institute of Community Health, University of Houston, Texas Medical Center, Houston, TX, USA; 5Department of Pharmaceutical Health Outcomes and Policy, University of Houston College of Pharmacy, Houston, TX, USACorrespondence: Osaro MgbereDisease Prevention & Control Division, Houston Health Department, 8000 North Stadium Drive, Houston, TX, 77054-1823, USATel +1-832-393-4593Email [email protected]: Few studies have estimated complete antiretroviral therapy (ART) adherence following HIV infection since the advent of the new ART guidelines in 2012. This study determined the prevalence and influence of sociodemographic, behavioral, and clinical factors on complete ART adherence among people living with HIV (PLWH) receiving medical care in Houston/Harris County, Texas.Methods: Data from the Houston Medical Monitoring Project survey collected from 2009 to 2014 among 1073 participants were used in this study. The primary outcome evaluated was combined adherence, defined as complete, partial, and incomplete combined adherence based on three ART adherence types—dose, schedule, and instruction adherence. The duration living since initial HIV diagnosis was classified as < 5, 5– 10 and > 10 years. Rao–Scott Chi-square test and multivariable proportional-odds cumulative logit regression models were employed to identify the sociodemographic, behavioral, and clinical characteristics of complete combined adherence among the three groups of PLWH living with HIV infection.Results: More than one-half (54.4%) of PLWH had complete, 37.4% had partial, and 8.3% had incomplete combined adherence. Among these PLWH, 52.2% had been infected with HIV for > 10 years, and 26.5% and 21.4% were infected for < 5 years and 5– 10 years, respectively. PLWH who were diagnosed < 5 and 5– 10 years were two times (aOR=1.71, 95% CI=1.13– 2.57; aOR=1.69, 95% CI=1.10– 2.59; respectively) more likely to experience complete combined adherence than those with > 10 years of infection. Multiple sociodemographic, behavioral, and clinical characteristics were significantly associated with complete adherence and varied by the duration of HIV infection.Conclusion: Measures of adherence should include all adherence types (dose, schedule, instruction), as utilizing a single adherence type will overestimate adherence level in PLWH receiving medical care. Intervention efforts to maintain adherence should target recently infected PLWH, while those aimed at improving adherence should focus on longer infected PLWH.Keywords: HIV, people living with HIV, antiretroviral therapy, medication adherence, Medical Monitoring Project
