Adherence to Early Antiretroviral Therapy
Adherence to Early Antiretroviral Therapy
Demographic variables for the sample are reported in the primary outcome article for HPTN 052 and are included in the Supplemental Appendix (see Supplemental Digital Content, http://links.lww.com/QAI/A654). Table 1 presents descriptive baseline data on the psychosocial and demographic data for the present sample. General health perception and mental health scores were in expected ranges, and most participants reported that they were either somewhat or very satisfied with social support. A small minority reported substance use, although almost 20% reported binge drinking. Only 4.2% of the sample reported less than 100% condom use during sex.
According to pill count, in the first month after ART initiation, 82.2% of participants were "adherent" (defined by 95% or greater levels) and 83.2% of participants were adherent 1 year after ART initiation. With respect to self-report items for how often they missed doses after ART initiation, 88.8% reported less than perfect adherence in the first month and 84.2% at 1 year. In the first month, the most frequent (more than 5%) reasons for nonadherence were forgot (40.4%), traveling away from home (19.3%), wanted to avoid side effects (17.0%), busy doing other things (9.4%), other illness or health problems got in the way (8.2%), and ran out of pills (6.4%). At 1 year, the most frequent reasons given for nonadherence were forgot (45.1%), busy doing other things (20.7), traveling away from home (22.6%), and ran out of pills (14%).
Pill Count Adherence.Table 2 and Table 3 present univariate and multivariable logistic regression analyses of psychosocial and demographic predictors of pill count adherence, inclusive of corresponding odds ratios, confidence intervals, and significance levels. According to the estimates in both the univariate and multivariable analyses, having a higher mental health score was the only statistically significant psychosocial predictor associated with greater adherence as measured by pill count. Geographic region (specifically, Asia and Africa vs. America) was also associated with adherence, with both groups having higher pill count adherence than America. In the univariate analyses, in addition to higher mental health scores, higher general health perceptions, and lower levels of unprotected sex were associated with greater adherence by pill count.
Self-report (PCA) Adherence Score.Table 2 and Table 3 also present univariate and multivariable linear regression analyses of psychosocial predictors of adherence measured by the self-report PCA scores, with corresponding unstandardized beta regression coefficient estimates, confidence intervals, and significance levels. Similar to the adherence by pill count, in both the univariate and the multivariable analyses, having a higher mental health score was statistically significantly associated with better adherence. However, in the analysis by geographic region, participants from Asia had lower self-reported adherence. Additionally, older age was associated with higher adherence in univariate analysis, but only marginally significant (P = 0.06) in multivariable analysis, Better social support (somewhat satisfied vs. very dissatisfied) was associated with better adherence in univariate analysis only.
Both univariate and multivariable analyses showed consistent significant associations between the self-report PCA medication adherence score and viral suppression (Table 4). In the multivariable analysis of pill count adherence, those categorized as being 95%–100% adherent were 1.42 times more likely to be virally suppressed; analysis of the self-report PCA adherence score showed each unit increase in the PCA resulting in a 1.20-fold increased likelihood of being virally suppressed.
Results
Demographic variables for the sample are reported in the primary outcome article for HPTN 052 and are included in the Supplemental Appendix (see Supplemental Digital Content, http://links.lww.com/QAI/A654). Table 1 presents descriptive baseline data on the psychosocial and demographic data for the present sample. General health perception and mental health scores were in expected ranges, and most participants reported that they were either somewhat or very satisfied with social support. A small minority reported substance use, although almost 20% reported binge drinking. Only 4.2% of the sample reported less than 100% condom use during sex.
Levels of Adherence and Reasons for Nonadherence
According to pill count, in the first month after ART initiation, 82.2% of participants were "adherent" (defined by 95% or greater levels) and 83.2% of participants were adherent 1 year after ART initiation. With respect to self-report items for how often they missed doses after ART initiation, 88.8% reported less than perfect adherence in the first month and 84.2% at 1 year. In the first month, the most frequent (more than 5%) reasons for nonadherence were forgot (40.4%), traveling away from home (19.3%), wanted to avoid side effects (17.0%), busy doing other things (9.4%), other illness or health problems got in the way (8.2%), and ran out of pills (6.4%). At 1 year, the most frequent reasons given for nonadherence were forgot (45.1%), busy doing other things (20.7), traveling away from home (22.6%), and ran out of pills (14%).
Longitudinal Models of Adherence
Pill Count Adherence.Table 2 and Table 3 present univariate and multivariable logistic regression analyses of psychosocial and demographic predictors of pill count adherence, inclusive of corresponding odds ratios, confidence intervals, and significance levels. According to the estimates in both the univariate and multivariable analyses, having a higher mental health score was the only statistically significant psychosocial predictor associated with greater adherence as measured by pill count. Geographic region (specifically, Asia and Africa vs. America) was also associated with adherence, with both groups having higher pill count adherence than America. In the univariate analyses, in addition to higher mental health scores, higher general health perceptions, and lower levels of unprotected sex were associated with greater adherence by pill count.
Self-report (PCA) Adherence Score.Table 2 and Table 3 also present univariate and multivariable linear regression analyses of psychosocial predictors of adherence measured by the self-report PCA scores, with corresponding unstandardized beta regression coefficient estimates, confidence intervals, and significance levels. Similar to the adherence by pill count, in both the univariate and the multivariable analyses, having a higher mental health score was statistically significantly associated with better adherence. However, in the analysis by geographic region, participants from Asia had lower self-reported adherence. Additionally, older age was associated with higher adherence in univariate analysis, but only marginally significant (P = 0.06) in multivariable analysis, Better social support (somewhat satisfied vs. very dissatisfied) was associated with better adherence in univariate analysis only.
Predictors of Viral Suppression
Both univariate and multivariable analyses showed consistent significant associations between the self-report PCA medication adherence score and viral suppression (Table 4). In the multivariable analysis of pill count adherence, those categorized as being 95%–100% adherent were 1.42 times more likely to be virally suppressed; analysis of the self-report PCA adherence score showed each unit increase in the PCA resulting in a 1.20-fold increased likelihood of being virally suppressed.
