Monday, November 3, 2003

This presentation is part of : The Patient Factor: Adherence Predicts Outcome across Chronic Disorders

Adherence, Quality of Life, and Clinical Response in Persons with HIV Infection

Judith A. Erlen, RN, PhD, FAAN1, Susan Sereika, PhD2, Mary Pat Mellors, RN, PhD1, Jacqueline Dunbar-Jacob, RN, PhD3, Susan Hunt, MD4, Christopher M. Ryan, PhD3, and John Mellors, MD4. (1) University of Pittsburgh School of Nursing, Pittsburgh, PA, USA, (2) Department of Health and Community Systems, Biostatistics, and Epidemiology, SON and Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA, (3) School of Nursing, The University of Pittsburgh, Pittsburgh, PA, USA, (4) CRCD, Pittsburgh, PA, USA

Objective: Purpose was to examine relationships between adherence to antiretroviral therapy, health related quality of life and clinical response.

Design: This is a descriptive correlation study.

Population, Sample, Setting: Patients infected with HIV (PWHIV), taking antiretroviral medications, and without HIV dementia were recruited through a university based clinic, community settings, and self-referral. The sample included 215 PWHIV (145 males, 70 females; 117 White, 73 African-American, 24 multi-racial/other). Ages ranged from 24- 61 years (mean=40.5 years).

Concept or Variables Studied Together: Variables included adherence (electronic event monitors (EEMs), Morisky Self-report Adherence Scale), clinical response (viral load, CD4 T-cell count), and health-related quality of life (MOS-HIV, Satisfaction with Life Scale).

Methods: Following enrollment, subjects used the EEM on a randomly selected antiretroviral medication for 30 days. Subjects completed paper and pencil tests. Clinical response data were obtained from medical records. EEM data were downloaded. Data were analyzed using Pearson r correlation coefficient.

Findings: Using EEMs adherence was 65%, taking prescribed number of doses; 47%, correct intake; 29%, days with no medication taken; 24%, near optimal inter-administration intervals; and 15%, days with prescribed number of doses and optimal inter-dose intervals. Self-reported adherence (Mean = 9.77) showed statistically significant correlations: CD4 T-cells = .180, viral load = -.274, satisfaction with life = .205, MOS-overall health = .315, and MOS-quality of life = .177. Percent correct administrations was significantly correlated with viral load (r = -.164); percent days with correct dose was significantly correlated with satisfaction with life (r = .152).

Conclusions: Using EEMs the adherence of PWHIV is poor when compared to the 95% level identified as necessary for good clinical outcomes. Self-reported adherence is related to improved clinical outcomes and quality of life.

Implications: Additional research is necessary to examine factors influencing adherence and test theory-based interventions designed to promote adherence.

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