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Randomized Controlled Trial
. 2006 Aug;21(8):835-40.
doi: 10.1111/j.1525-1497.2006.00527.x.

Health literacy, antiretroviral adherence, and HIV-RNA suppression: a longitudinal perspective

Michael K Paasche-Orlow  1 , Debbie M Cheng, Anita Palepu, Seville Meli, Vincent Faber, Jeffrey H Samet
Affiliations
Randomized Controlled Trial

Health literacy, antiretroviral adherence, and HIV-RNA suppression: a longitudinal perspective

Michael K Paasche-Orlow et al. J Gen Intern Med. 2006 Aug.

Abstract

Background: Low health literacy has been associated with worse adherence to antiretroviral therapy (ART) and higher HIV-RNA levels, but these relationships have not been evaluated in longitudinal analyses.

Methods: We evaluated literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) (< or = 6th grade, 7th to 8th grade, > or = 9th grade) in the HIV-Alcohol Longitudinal Cohort study of HIV-infected persons with a history of alcohol problems, conducted from 1997 to 2001. We tested HIV-RNA levels and administered a standardized questionnaire regarding demographics, substance use, receipt of ART, and adherence with ART, every 6 months for up to 7 occasions. Among the 235 subjects on ART, we investigated the relationship between literacy and 2 outcomes: 100% 3-day self-reported adherence and HIV-RNA suppression (<500 copies).

Results: Subjects' literacy levels were the following: 14% < or = 6th grade, 29% 7th to 8th grade, and 57% > or = 9th grade. In 66% of the observations (478/725), subjects reported 100% 3-day adherence with ART. Of the 685 HIV-RNA assays from these subjects, 62% had <500 copies. In unadjusted analyses, subjects with the lowest literacy level (< or = 6th grade) had a higher odds of adherence (odds ratio [OR] 2.23, 95% confidence interval 1.15 to 4.30) and HIV-RNA suppression (OR 2.01, 95% confidence interval 1.03 to 3.90) compared with those with > or = 9th grade literacy. This trend persisted but was no longer statistically significant in adjusted models of adherence (AOR 1.93, 95% confidence interval 0.86 to 4.31) and HIV-RNA suppression (AOR 1.70, 95% confidence interval 0.79 to 3.65).

Conclusion: Contrary to our hypothesis, low literacy was not associated with a lower odds of adherence or virologic suppression in this longitudinal analysis of HIV-infected patients with a history of alcohol problems. Indeed, trends in these data suggest the possibility that low literacy may be associated with a higher odds of adherence and virologic suppression. These counterintuitive findings underscore the need to pursue a fuller understanding of the mechanisms by which literacy affects health outcomes.

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Figures

FIGURE 1
FIGURE 1
Sampling cascade for the analytic cohort.
See this image and copyright information in PMC

References

    1. Institute of Medicine. Priority Areas for National Action: Transforming Health Care Quality. Committee on Identifying Priority Areas for Quality Improvement. In: Adams K, Corrigan JM, editors. Washington, DC: National Academies Press; 2003. - PubMed
    1. Carmona RH Sugeon General of the United States. Health Literacy in America: The Role of Health Care Professionals. Prepared remarks given at the American Medical Association House of Delegates Meeting. 2003. [February 19, 2004]. Saturday, June 14. Available at: http://www.surgeongeneral.gov/news/speeches/ama061403.htm.
    1. Nielsen-Bohlman LT, Panzer AM, Hamlin B, Kindig DA Institute of Medicine. Committee on Health Literacy, Board on Neuroscience and Behavioral Health. Washington, DC: National Academies Press; 2004. Health Literacy: A Prescription to End Confusion. - PubMed
    1. Paasche-Orlow MK, Parker RM, Gazmararian JA, Nielsen-Bohlman LT, Rudd RR. The prevalence of limited health literacy. J Gen Intern Med. 2005;20:175–84. - PMC - PubMed
    1. Rudd RE, Moeykens BA, Colton TC. Health and literacy: a review of medical and public health literature. In: Comings J, Garners B, Smith C, editors. Health and Literacy. 1. New York: Jossey-Bass; 1999.

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