4.7 Article

Factors associated with non-adherence to long-term highly active antiretroviral therapy: a 10 year follow-up analysis with correction for the bias induced by missing data

Journal

JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
Volume 64, Issue 3, Pages 599-606

Publisher

OXFORD UNIV PRESS
DOI: 10.1093/jac/dkp232

Keywords

HIV; ARV; HAART; self-reports; selection models; Heckman two-step

Funding

  1. Agence Nationale de Recherches sur le Sida et les hepatites virales (ANRS)
  2. College des Universitaires de Maladies Infectieuses et Tropicales (CMIT ex APPIT)
  3. Sidaction Ensemble contre le Sida
  4. Abbott
  5. Boehringer-Ingelheim
  6. Bristol-Myers Squibb
  7. GlaxoSmithKline
  8. Roche

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Objectives: The aim of this study was to identify factors associated with non-adherence over a 10 year follow-up of the APROCO-COPILOTE cohort during the maintenance phase of highly active antiretroviral therapy (HAART). Methods: Overall, 1010 patients participated in this analysis, each having had at least 12 months of follow-up after HAART initiation and at least one self-reported adherence measure available during the follow-up period (month 12-month 120). Data collection was based on clinical records and self-administered questionnaires that gathered patients' psychosocial characteristics and experience with HIV disease and treatment. First, a generalized estimating equations (GEE) model was used to identify non-adherence predictors. Secondly, a Heckman two-stage approach was used in order to account for missing data bias and to measure the extent to which this could affect the results of the first model. Results: Non-adherent behaviour was reported by 747 patients (2070 visits). After correcting for the bias due to missing data, non-adherence was independently associated with side effects, having a three times or more daily dosing regimen, experience of being at clinical stage B/C and being diagnosed as HIV-positive for < 6 months. Non-adherence was more likely among patients who were younger, had children, were born in the European Union, had depressive symptoms, consumed alcohol daily and declared a lack of support from their main partner. Adjusting for missing outcome data changed the pattern of predictors. Conclusions: Reasons for non-adherence depended on both psychosocial conditions and treatment-related characteristics. To improve long-term patient outcomes for those at risk of adherence failure, tailor-made patient-specific psychosocial interventions and regimen-based strategies with improved tolerance need to be implemented.

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