Factors Associated With Nonadherence to Antiretroviral Therapy Among Young People Living With Perinatally Acquired HIV in England.
Ali Judd, Diane Melvin, Lindsay C Thompson and 9 others
PMID 32467489WHAT IT FOUND
41% reported missing doses.
Forgetting was the main reason (68%). Poor quality of life, worse HIV self-perception, telling more people about HIV, and boosted protease inhibitor regimens were linked to missed doses.
Key findings
0141% (106/261) of young people reported missing doses on either adherence measure, and among those reporting both 3-day and last-month nonadherence, 52% (23/44) had suppressed viral load compared with 88% (127/145) among those reporting adherence on both measures.
02Forgetting was the main reason for missing doses (72/106, 68%), and other reported reasons included being away from home (37%), being asleep at the dose time (30%), feeling too tired (29%), not being able to deal with antiretroviral therapy that day (24%), not wanting others to know (23%), school hours interfering with adherence (23%), and running out of antiretroviral drugs (15%).
03In adjusted models, each 25-point drop in quality of life was linked to 2.39 times higher odds of 3-day nonadherence, boosted protease inhibitor-based regimens were linked to 2.67 times higher odds than nonnucleoside reverse transcriptase inhibitor-based regimens, worse HIV self-perception was linked to 1.17 times higher odds per 5-point decrease, telling three or more people about HIV was linked to 3.29 times higher odds than telling none, and boosted protease inhibitor-based regimens were linked to 2.25 times higher odds than nonnucleoside reverse transcriptase inhibitor-based regimens for last-month nonadherence.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Adherence was self-reported, and the study notes there is no gold standard measure of adherence. The adherence questions only asked about missing doses in the last 3 days and missing more than 2 days in a row in the last month, so other periods of nonadherence may have been missed. The data were collected at the baseline interview, so the study could not show whether factors such as quality of life, self-perception, disclosure, or regimen type came before or after missed doses. The sample size was powered for comparisons between people with perinatally acquired HIV and HIV-uninfected young people, not for differences within the group with perinatally acquired HIV. Some themes had fewer variables, and the study did not measure felt stigma, psychiatric comorbidity, drug resistance, transition preparedness, medication responsibility, motivation, behavioural skills, or self-efficacy. Not all recruited participants answered the adherence questions, so the analysed sample was smaller than the recruited sample.
Declared interests
The authors report no real or perceived vested interests that could be construed as a conflict of interest. The supplied metadata lists non-U.S. government research support, but the text does not name a funder or say the sponsor designed the study.
The easy way to misread this
Do not tell young people that disclosing their HIV status will make adherence worse. The study found an association at one baseline interview, not that disclosure caused missed doses, and it could not separate cause from consequence.