FACTORS ASSOCIATED WITH POOR HIGHLY ACTIVE ANTIRETROVIRAL THERAPY (HAART) MEDICATION ADHERENCE AMONG OLDER ADULTS LIVING WITH HIV IN THE U.S.
Abstract
Background: In the U.S., the number of individuals living with HIV aged 50 years and older has been consistently increasing. Using Centers for Disease Control and Prevention epidemiological data, researchers estimated that in 2015, more than half of the individuals living with HIV in the U.S. were over the age of 50. Optimal adherence to HIV treatment regimens can greatly reduce morbidity and mortality among this population, as well as reduce the risk of transmission of the virus to others. Few studies have examined the association between behavioral and psychological characteristics and HIV medication adherence among an older population. Objective: This study evaluated the association between adherence and the following patient-reported outcomes: hazardous alcohol use, substance use, depression, quality of life, symptom burden, and physical activity level. Methods: Using data from the Centers for AIDS Research’s Network of Integrated Clinical Systems (CNICS) project, a cross-sectional study was performed among 3,309 patients age 50 and older from seven different clinics in urban centers across the U.S. Exposure and outcome data were self-reported and collected through reliable and valid survey tools. Logistic regression analyses were conducted to explore relationships between each of the patient-reported outcomes and medication adherence. Multivariate logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), controlling for race/ethnicity, gender, age, clinic site, chronic illness comorbidity, and risk category. Results: There were statistically significant associations between all of the patient reported outcomes and adherence, with the one exception of physical activity level. Hazardous alcohol drinkers and current substance users had increased odds of poor adherence (OR=1.50; 95% CI: 1.24-1.82 and OR=3.83; 95% CI: 2.96-4.97, respectively). Patients with mild or severe depressive symptoms had almost 60% increased odds of poor adherence (OR=1.58; 95% CI: 1.30-1.93 and OR=1.56; 95% CI: 1.05-2.32, respectively), and patients with moderate depressive symptoms had more than twice the odds of poor adherence (OR=2.28; 95% CI: 1.85-2.82) as compared to patients with no depressive symptoms. Participants with low quality of life scores and patients with high levels of symptom burden had nearly a two-fold increased odds of poor adherence (OR=1.86; 95% CI: 1.35-2.55 and OR=1.74; 95% CI: 1.07-2.84, respectively). Clinic site was not an effect modifier for any of the patient reported outcome-adherence associations. Risk category was an effect modifier of the association between hazardous alcohol use and poor adherence (test of homogeneity p-value=0.05), but did not modify any of the other patient reported outcome-adherence associations. Conclusions: Older adults should be assessed for the risk of poor adherence. Research findings from this study may provide mental health and addiction screening tools for health care providers to assess the risk of poor medication adherence among older patients. Such screenings could identify patients who would benefit from adherence counseling or other interventions. Additional studies are needed to confirm these findings. Ultimately, better adherence would lead to improvements in viral suppression, reductions in morbidity and mortality, and decreased risks of transmitting the virus to others.