HIV Medication Adherence: Reasons for Missed Medication and Rethinking the Trajectory
- Author(s): Okonsky, Jennifer Geralyn
- Advisor(s): Portillo, Carmen J
- et al.
HIV medication adherence is critical for HIV viral suppression and reducing morbidity and mortality. Adherence rates are below optimal levels and women have poorer adherence compared to men. Fifty percent of people treated with antiretroviral therapy (ART) are resistant to at least one medication. Current interventions are costly and magnitude of improvement is often small. Three studies were conducted to examine the reasons why people are missing their medications and the relationship with documented factors. The first study examined key correlates and reasons for missed medication in people from nine cities in the US using an ordinal regression model. Problems taking pills (PTP), (a factor of five reasons) was significantly associated (p=.003) with use of a protease inhibitor (PI) regimen. A person taking a PI regimen is 1.7 odds of having more PTP versus a non-PI based regimen. Symptom experience (OR: 3.8; 95% CI: 2.7, 5.2) and other health conditions (OR: 0.7; 95% CI: .45, .98) were found to be independently associated with PTP. The second study's purpose was to examine and gain an appreciation of the reasons why HIV infected women taking ART in the US are missing their HIV medications, and how the results can influence a new trajectory of adherence research. Women were 2.2 times more likely to document reasons pertaining to forgetfulness than PTP, (OR= 2.2, 95% CI: 1.63, 2.94, p<0.001). There was a difference between the adherent and non-adherent groups in reasons for missed medications given overall, but no difference between those on a PI-based versus a non-PI-based regimen. The final study examined women using a self-management framework and analyzed reasons for non-adherence according to contextual, process and outcome factors. The reasons, `wanting to avoid side effects' and `being away from home' were found to have a significant difference when associated with race and employment. The three studies suggest translating the evidence of a common profile of non-adherence into a proactive individual discussion, engaging the patient-provider relationship to appreciate the reasons for intentional or unintentional non-adherence and offers a self-management framework to organize adherence discussions and intervention development.