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. 2017 Nov 8:11:1897-1906.
doi: 10.2147/PPA.S141762. eCollection 2017.

Highly specific reasons for nonadherence to antiretroviral therapy: results from the German adherence study

Johanna Boretzki  1   2 , Eva Wolf  3 , Carmen Wiese  4 , Sebastian Noe  4 , Annamaria Balogh  3 , Anja Meurer  5 , Ivanka Krznaric  6 , Alexander Zink  7 , Christian Lersch  1 , Christoph D Spinner  1   2
Affiliations

Highly specific reasons for nonadherence to antiretroviral therapy: results from the German adherence study

Johanna Boretzki et al. Patient Prefer Adherence. .

Abstract

Background: 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.

Methods: 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.

Results: 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%, p<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 (p<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 (p<0.05).

Conclusion: 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.

Keywords: ART; HIV; adherence; antiretroviral therapy; human immunodeficiency virus; nonadherence; patients’ beliefs.

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Conflict of interest statement

Disclosure CW received travel grants from AbbVie, Bristol-Meyers Squibb, Gilead Science, and Jansen. AZ received travel grants from AbbVie, Bristol-Meyers Squibb, Gilead Sciences, and MSD. IK received travel grants from ViiV, Abbvie, MDS, Gilead, and Bristol-Meyers Squibb. The other authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of the process of patients’ inclusion and categorization into adherence groups A, B, and C (good, unstable, or poor adherence, respectively), based on physicians’ adherence assessment.
Figure 2
Figure 2
Differences in self-reported reasons for nonadherent behavior between the adherence groups. Note: p-values were calculated using the Fisher’s extended exact test. Abbreviation: ART, antiretroviral therapy.
See this image and copyright information in PMC

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