Barriers to Follow-Up Care and Medication Adherence to HAART in Severe Mentally Ill Patients with HIV/AIDS: A Retrospective Chart Review

Wednesday, July 13, 2011: 3:45 PM

Jodi Simpson, RN, BS, MS, NPP, FNP
School of Nursing, State University of New York at Stony Brook, Stony Brook, NY

Learning Objective 1: Describe the importance of providing care to mentally ill on HAART that includes identifying potential barriers for compliance with treatment plan including medication and appointments

Learning Objective 2: Understand the need for a structured resource guide to help educate and expand practitioner’s knowledge in providing care to severely mentally ill patients on HAART

Purpose: Evidence pertaining to HIV patients with severe mental illness and adherence to medications is scant.  The purpose of this study was to explore barriers to medication adherence among severe mentally ill patients on HIV drug regimen and to provide recommendations for implementing a standard guideline resource tool for care. 

Methods:  A retrospective chart review (N=100) was conducted and factors associated with nonadherence were analyzed.  

Results: Barriers identified were gender, compliance with psychiatric appointments, and HIV appointments, and the length of time in psychiatric treatment.  Major Depression (61.0 %), Bipolar Disorder (25.0 %) and Schizophrenia (6.0 %) are the predominant psychiatric disorders.  T tests showed a relationship that females had higher Cd4 counts.  Chi square tests showed compliance to psychiatric appointments was related to adherence to psychiatric medications.  It also showed subjects that kept their psychiatric appointments are likely to keep their HIV care appointments (X²= 7.7(1), p=.006).  Pearson correlation shows a positive weak correlation between Cd4 count and the length one has been receiving psychiatric treatment (R=.318).

Conclusion: There are a number of barriers to compliance with HIV care but chart documentation is lacking in regards to the reasons for missed appointments and noncompliance with psychiatric or HIV medications.  This data give rise to the need for standard guideline and resource tool to improve treatment and medication adherence to improve health care.  Implementing this guideline will lead to decrease in the number of opportunistic infections and lessen drug resistant in patient receiving HIV therapy.