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Section D

Section D. Addiction and Other Factors Associated with HIV Medication Adherence: Results of Univariate Analyses. James Bell, James Bell Associates for co-author Claude Mellins, New York State Psychiatric Institute and Columbia University, Cheryl McDonnell, James Bell Associates

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Section D

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  1. Section D Addiction and Other Factors Associated with HIV Medication Adherence: Results of Univariate Analyses James Bell, James Bell Associates for co-author Claude Mellins, New York State Psychiatric Institute and Columbia University, Cheryl McDonnell, James Bell Associates and Margaret Chesney (NICAM

  2. Rationale Among people with mental illness and substance abuse, it is unclear who is most likely to adhere to HIV medications without external supervision.

  3. Research Questions • What is the association between substance abuse and mental illness and adherence to antiretroviral (ARV) medications? • What specific types of mental illness or substance abuse are associated with non-adherence? - What protective factors, such as presence of a partner, employment, housing, education, income, or spirituality predict adherence?

  4. Methods • A subset of 383 adult participants (from a HIV/AIDS Cost Study sample of 1138) who self-managed their HIV medication adherence was identified. - Adherent was defined as taking 95% or more of prescribed pills over a 3-day period (Chesney et al., 2000). - Adherent participants were compared to non-adherents on an array of clinical, demographic, socio-economic and service utilization factors derived from baseline assessments. - A total of 90 variables, which also included Site indicator variables, were examined in their own models for this subset of participants. - Univariate correlates of ARV adherence were determined by applying generalized linear modeling (using the SAS GLM program). - Predictors significantly related to adherence with an associated p-value < 0.05 were identified.

  5. ARV Adherence Level - Among those who self-managed ARV adherence, 59 percent were adherent compared to 67 percent for the entire study population of persons with complex physical and behavioral co-morbidities. • For 69 percent of those not on antiretroviral medications, the decision not to take medications is considered a patient decision.

  6. Demographic and Socio-Economic Characteristics - Being older [OR 1.03 (1.005, 1.06)], being white [OR 2.35 (1.21, 4.57)], having greater spirituality [OR 1.56 (1.16, 2.09)], fewer roommates [OR 0.83 (0.71, 0.96)], and having fewer legal problems [OR 0.10 (0.01, 0.76)] increased the odds of ARV adherence. - Many of the demographic variables that were expected to be positively associated with adherence (e.g. education, martial/partner status, being employed, income) were not for this study population.

  7. Drug Use • Use in past 30 days of marijuana [OR 0.47 (0.29, 0.76)], powder cocaine [OR 0.50 (0.30, 0.82)] and crack cocaine [OR 0.46 (0.28, 0.74)] decreased the odds of ARV adherence. - A greater number of days of marijuana use [OR 0.97 (0.95, 0.996)] and crack cocaine [OR 0.95 (0.92, 0.98)] use in past 30 daysas well as lifetime drug use [OR 0.28 (0.11, 0.74)] also decreased the odds of ARV adherence. - ASI Drug Composite Score, whetherdrugs were used in past 30 days, and use of methadone in past 30 days (with or without other drugs and whether or not for medicinal purposes) were among the drug use factors not associated with adherence.

  8. Alcohol Use • Alcohol use in the past 30 days [OR 0.44 (0.25, 0.76)] and alcohol use to intoxication in the past 30 days [OR 0.55 (0.34, 0.89)] were associated with decreased odds of ARV adherence. - ASI Alcohol Composite Score andwhether alcohol was used in the past 6 months were among the alcohol use factors not associated with adherence.

  9. Mental Health • A diagnosis of non-mood psychosis [OR 3.00 (1.35, 6.68)] and being prescribed psychiatric medication [OR 1.69 (1.04, 2.75)] increased the odds of ARV adherence. (It is not clear why those with a psychosis diagnosis exhibited greater adherence to ARV medications (62%) than those without such a diagnosis (52%): although they are more likely to have been prescribed psychiatric medications (56% vs. 39%), they are no more likely to adhere to psychiatric medications.) - SF-36 Mental Health Composite Score and whether the participant was prescribed psychiatric medications were among the mental health factors not associated with adherence to ARV medications.

  10. Health Services Utilization • Keeping at least one medical appointment in the past 3 months [OR 2.43 (1.17, 5.05)] as well as a greater number of medical visits [OR 1.09 (1.00, 1.19)] or a greater number of mental health visits in the past 3 months [OR 1.08 (1.00, 1.16)] were associated with increased odds of ARV adherence. - Keeping at least one appointment with a substance abuse treatment provider in the past 3 months was among the service utilization factors not associated with adherence to ARV medications.

  11. Preliminary Conclusions about Predictors of Adherence - A majority of patients with co-occurring substance abuse and mental illness were able to self-manage adherence to ARVs. - A limited set of specific factors, particularly components of substance abuse, were associated with non-adherence in this cohort of patients with complex co-morbidities and compelling demographic and socio-economic disadvantages.

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