Medication persistence in the treatment of HIV infection: A review of the literature and implications for future clinical care and research

AIDS (London, England) (Impact Factor: 6.56). 01/2011; 25(3):279-90. DOI: 10.1097/QAD.0b013e328340feb0
Source: PubMed

ABSTRACT Persistence, continuous treatment with a prescribed medication or intervention, is an important, but underrecognized aspect of medication treatment, especially for HIV. In contrast to adherence, which measures the percentage of patient behavior to a prescribed therapy, persistence measures the duration during which a patient remains on a prescribed therapy. Decreased persistence for HIV treatment, or shorter duration on therapy, is associated with increased rates of virological failure, development of antiretroviral resistance, and increased morbidity and mortality. Additionally, frequency and duration of nonpersistent episodes rather than adherence may be a better predictor of clinical outcomes in HIV-infected patients on certain regimens. In this review, we codify the constructs of persistence and adherence, and further define persistence as either patient or regimen persistence. Furthermore, current literature on the clinical consequences of and factors associated with suboptimal persistence is summarized. Finally, methods to measure persistence as well as interventions that may improve persistence and clinical outcomes are suggested.

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Available from: Frederick Altice, Nov 11, 2014
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    • "Consistent with previous studies (Bae et al., 2011; Carrico et al., 2011), participants who initiated ART and remained on it during all subsequent assessments that were completed over the 18-month investigation period were classified as engaging in ART persistence (1) and compared to those who didn't initiate or inconsistently utilized ART (0). "
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    ABSTRACT: Objective: Revised Stress and Coping Theory proposes that positive affect serves adaptive functions, and its beneficial effects are heightened during stressful periods. This study examined the prospective relationship between positive affect and engagement in care during the 18 months after a HIV seropositive diagnosis. Methods: The Coping, HIV, and Affect Interview (CHAI) cohort study enrolled 153 individuals who had recently received a HIV seropositive diagnosis. Using logistic and linear regression, baseline positive affect was examined as a predictor of linkage to HIV care, antiretroviral therapy (ART) persistence (i.e., starting ART and remaining on it during subsequent follow-up assessments), and mean log10 HIV viral load over follow-up. Results: After controlling for education, T-helper (CD4+) count, HIV viral load, and negative affect, higher baseline positive affect independently predicted increased odds of linkage to HIV care at 3 months postdiagnosis (adjusted OR [AOR] = 1.10; 95% CI = 1.01-1.21) and ART persistence over the 18-month follow-up period (AOR = 1.08; 95% CI = 1.01-1.16). Positive affect was not directly associated with lower mean HIV viral load over follow-up. However, one standard deviation higher positive affect indirectly predicted 6.7% lower HIV viral load via greater odds of ART persistence (βindirect = -0.18, p < .05). Conclusions: Greater positive affect predicts linkage to HIV care and ART persistence. ART persistence, in turn, is associated with lower HIV viral load. Clinical research is needed to examine whether interventions designed to enhance positive affect can boost the effectiveness of HIV treatment as prevention. (PsycINFO Database Record (c) 2013 APA, all rights reserved).
    Health Psychology 11/2013; 33(7). DOI:10.1037/hea0000011 · 3.95 Impact Factor
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    • "Intimate partner violence (IPV) can be a major barrier to longitudinal HIV care, including persistence on antiretroviral therapy (ART) (Bae et al., 2011; Schafer et al., 2012). Poor retention in care along the HIV treatment cascade reduces the likelihood of ultimately achieving viral suppression and increases risk of ongoing HIV transmission (Cohen et al., 2011; Andrews et al., 2012; Gardner et al., 2011). "
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    ABSTRACT: Little is known about the association of intimate partner violence (IPV) with specific HIV treatment outcomes, especially among criminal justice (CJ) populations who are disproportionately affected by IPV, HIV, mental and substance use disorders (SUDs) and are at high risk of poor post-release continuity of care. Mixed methods were used to describe the prevalence, severity, and correlates of lifetime IPV exposure among HIV-infected jail detainees enrolled in a novel jail-release demonstration project in Connecticut. Additionally, the effect of IPV on HIV treatment outcomes and longitudinal healthcare utilization was examined. Structured baseline surveys defined 49% of 84 participants as having significant IPV-exposure, which was associated with female gender, longer duration since HIV diagnosis, suicidal ideation, having higher alcohol use severity, having experienced other forms of childhood and adulthood abuse, and homo/bisexual orientation. IPV was not directly correlated with HIV healthcare utilization or treatment outcomes. In-depth qualitative interviews with 20 surveyed participants, however, confirmed that IPV was associated with disengagement from HIV care especially in the context of overlapping vulnerabilities, including transitioning from CJ to community settings, having untreated mental disorders, and actively using drugs or alcohol at the time of incarceration. Post-release interventions for HIV-infected CJ populations should minimally integrate HIV secondary prevention with violence reduction and treatment for SUDs.
    International Journal of Prisoner Health 09/2013; 9(3):124-141. DOI:10.1108/IJPH-03-2013-0011
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    • "In addition, subjects were examined for persistence on BMT, a concept that recognizes recurrent treatment episodes (Bae et al., 2011; Ing et al., 2011). Treatment persistence was defined as receiving buprenorphine prescriptions continuously without any gaps in treatment of 2 weeks or more. "
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    ABSTRACT: BACKGROUND: Few studies have examined real-world effectiveness of integrated buprenorphine maintenance treatment (BMT) programs in federally qualified health centers (FQHCs). METHODS: Opioid dependent patients (N=266) inducted on buprenorphine between July 2007 and December 2008 were retrospectively assessed at Connecticut's largest FQHC network. Six-month BMT retention and opioid-free time were collected longitudinally from electronic health records; 136 (51.1%) of patients were followed for at least 12 months. RESULTS: Participants had a mean age of 40.1 years, were primarily male (69.2%) and treated by family practitioners (70.3%). Co-morbidity included HCV infection (59.8%), mood disorders (71.8%) and concomitant cocaine use (59%). Retention on BMT was 56.8% at 6 months and 61.6% at 12 months for the subset observed over 1 year. Not being retained on BMT at 12 months was associated with cocaine use (AOR=2.18; 95% CI=1.35-3.50) while prescription of psychiatric medication (AOR=0.36; 95% CI 0.20-0.62) and receiving on-site substance abuse counseling (AOR=0.34; 95% CI 0.19, 0.59) improved retention. Two thirds of the participants experienced at least one BMT gap of 2 or more weeks with a mean gap length of 116.4 days. CONCLUSIONS: Integrating BMT in this large FQHC network resulted in retention rates similarly reported in clinical trials and emphasizes the need for providing substance abuse counseling and screening for and treating psychiatric comorbidity.
    Drug and alcohol dependence 01/2013; 131(1-2). DOI:10.1016/j.drugalcdep.2012.12.008 · 3.28 Impact Factor
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