Parameters associated with adherence to antiretroviral therapy in HIV-infected Australian adults: The PAART Study

Stream: HIV Treatment: Issues in uptake and adherence
Date: Thursday, 31 March 2016
Time: 1.45 pm – 3.00 pm

Abstract

Introduction: Some patients have difficulty maintaining antiretroviral therapy (ART) adherence, reasons for this in Australia are not well understood. Methods: We developed a national, 2-year cohort study of HIV-positive adults on ART with undetectable viral load. Participants complete an annual questionnaire regarding demographics, physical health, psychosocial stressors, HIV disclosure, stigma/discrimination, healthcare access, treatment adherence/side effects, health/treatment perceptions, and finances/employment. Neurocognition is assessed using Cogstate. Pharmacy ART dispensing data are collected annually; clinical/virological outcomes bi-annually. Results: We present baseline data for the first 350 participants: 332 (94.9%) male, mean age 50.6 years, mean HIV-duration 14 years. Participants were recruited at 11 sites: 144 (41%) at sexual health clinics, 114 (33%) hospital clinics, 92 (26%) general practices. 43 participants (12.3%) reported missing ≥1 ART dose in previous week; 42 participants (12.0%) missed ≥1 dose/month over previous 3 months. 31 variables associated with incomplete ART adherence over past-week in univariate analyses, including >1 ART pill per day, and methamphetamine use, but not neurocognitive impairment (GDS≥0.5, in 27.1%)/pharmacy copayments. In forward logistic regression, increased odds for non-adherence independently associated with: born outside Australia (OR=4.9 [95%CI 1.5-15.7], p=0.007); prior AIDS-defining illness (OR 3.6 [95%CI 1.5-8.6], p=0.004); having delayed/interrupted ART in previous 12 months (OR=13.3 [95%CI 3.0-58.8], p=0.001); currently living alone (OR=3.8 [95%CI 1.5-9.6], p=0.004); and current depression (PHQ-9 summary score >10) (OR 2.7 [95%CI 1.1-7.1], p=0.038). Discussion: In HIV-positive adults on suppressive ART, 12% report suboptimal short-term adherence at levels associated with ART failure. Non-adherence mostly associated with psychosocial factors rather than ART/medical parameters.

Authors

Krista J Siefried (Presenter), St Vincent's Clinical School UNSW, St Vincent's Centre for Applied Medical Research
Krista has a background in Nursing and Science, and is currently completing her PhD at UNSW.

Limin Mao, Centre for Social Research in Health
Dr Limin Mao is a Senior Research Fellow at the Centre for Social Research in Health. Her cross-disciplinary training in Medicine, Public Health (Epidemiology), and Social Sciences (Education and Psychology) enables her to bring a range of theoretical perspectives and mixed-method research skills into the team. Dr Mao has extensive experience in conducting, analysing, and interpreting cross-sectional surveys and prospective observational cohort studies.

Stephen Kerr, UNSW, St Vincent's Centre for Applied Medical Research
My research interests are about rational drug use, clinical trials, neurocognitive development in children and adolescents living with HIV and HPV/HIV co-infection.

Thomas Gates, St Vincent's Centre for Applied Medical Research
Tom is a neuropsychologist with interests in HIV and TBI.

Lucette Cysique, Neuroscience Research Australia, UNSW
Research Interests:
1. Modelling neurocognitive and brain changes based on chronic conditions such as HIV infection, Hepatitis C infection, aging and cardio-vascular diseases in HIV infection. Using combination of neuropsychological and neuroimaging methods to improve our understanding of neurocognitive deterioration, but also neurocognitive improvement including compensatory strategies, and brain repair mechanisms. 2. Development of crosssectional and longitudinal normative neuropsychological data. 3. Cross-cultural neuropsychology

John deWit, Centre for Social Research in Health, UNSW
Professor John de Wit is Director of the Centre for Social Research in Health. John is an internationally recognised leader in social and behavioural research with respect to health and sexuality, with recent highlights including co-chairing of a track committee at the World AIDS Conference 2014 and speaking as a keynote at the International Conference of Applied Psychology 2014.

Andrew Carr, Centre for Applied Medical Research, St Vincent’s Hospital
Andrew Carr is director of the St Vincent's Hospital Immunology and Infectious Diseases department, and head of the Clinical Research Program, Centre for Applied Medical Research, St Vincent’s Hospital.