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- Title:
Highly specific reasons for nonadherence to antiretroviral therapy: results from the German adherence study.
- Document type:
- Journal Article; Article
- Author(s):
- Boretzki, Johanna; Wolf, Eva; Wiese, Carmen; Noe, Sebastian; Balogh, Annamaria; Meurer, Anja; Krznaric, Ivanka; Zink, Alexander; Lersch, Christian; Spinner, Christoph D
- Abstract:
- Reasons for and frequency of nonadherence to antiretroviral therapy (ART) may have changed due to pharmacological improvements. In addition, the importance of known non-pharmacologic reasons for nonadherence is unclear.We performed a cross-sectional, noninterventional, multicenter study to identify current reasons for nonadherence. Patients were categorized by physicians into the following adherence groups: good, unstable, or poor adherence. Co-variables of interest included age, sex, time since HIV diagnosis, ART duration, current ART regimen, HIV transmission route, comorbidity, HIV-1 RNA viral load (VL), and CD4 cell count. Patients self-reported the number of missed doses and provided their specific reasons for nonadherent behavior. Statistical analyses were performed using Fisher's extended exact test, Kruskal-Wallis test, and logistic regression models.Our study assessed 215 participants with good (n=162), unstable (n=36), and poor adherence (n=17). Compared to patients with good adherence, patients with unstable and poor adherence reported more often to have missed at least one dose during the last week (good 11% vs unstable 47% vs poor 63%, <0.001). Physicians' adherence assessment was concordant with patients' self-reports of missed doses during the last week (no vs one or more) in 81% cases. Similarly, we found a strong association of physicians' assessment with viral suppression. Logistic regression analysis showed that "reduced adherence" - defined as unstable or poor - was significantly associated with patients <30 years old, intravenous drug use, history of acquired immune deficiency syndrome (AIDS), and psychiatric disorders (<0.05). Univariate analyses showed that specific reasons, such as questioning the efficacy/dosing of ART, HIV stigma, interactive toxicity beliefs regarding alcohol and/or party drugs, and dissatisfaction with regimen complexity, correlated with unstable or poor adherence (<0.05).Identification of factors associated with poor adherence helps in identifying patients with a higher risk for nonadherence. Reasons for nonadherence should be directly addressed in every patient, because they are common and constitute possible adherence intervention points.
- Journal title abbreviation:
- Patient Prefer Adherence
- Year:
- 2017
- Journal volume:
- 11
- Pages contribution:
- 1897-1906
- Language:
- eng
- Fulltext / DOI:
- doi:10.2147/PPA.S141762
- Pubmed ID:
- http://view.ncbi.nlm.nih.gov/pubmed/29184394
- Print-ISSN:
- 1177-889X
- TUM Institution:
- II. Medizinische Klinik und Poliklinik (Gastroenterologie); Klinik und Poliklinik für Dermatologie und Allergologie
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