Intention to Adhere to HIV Treatment
Intention to Adhere to HIV Treatment
The survey was distributed to 311 patients at two HIV clinics. Fifteen incomplete surveys were excluded from analysis. An additional 43 were excluded because the respondents were not on HAART. Nine were excluded because the respondents had started HAART too recently to measure adherence during the past month. Results from the remaining 244 questionnaires were included in this analysis (Fig 2).
(Enlarge Image)
Figure 2.
Flowchart for participant exclusion. HAART, highly active antiretroviral therapy.
Sixty-eight per cent of the patients were adherent during the last month. Table 1 shows the baseline characteristics of the study population with comparisons between adherent and nonadherent participants based on the primary outcome of adherence during the last month. The mean age of the participants was 52 years; 92% were male and more than 50% were Black. Sixty per cent had some college education and 70% had adequate functional health literacy. Sixty-two per cent reported having an HIV diagnosis for over 10 years. Seventy-nine per cent came from the VA site. The adherent and nonadherent groups did not differ significantly in terms of age, gender, race, education, health literacy, time since diagnosis, or site.
As expected, adherent participants had significantly higher CD4 count than nonadherent participants (mean 528 vs. 431 cells/μL, respectively; P < 0.01), had significantly lower viral load (mean 1.8 vs. 2.3 log10 copies/mL, respectively; P < 0.001) and were significantly more likely to have undetectable viral load (97% vs. 81%, respectively; P < 0.0001). Overall, 217 patients (92%) had undetectable viral load.
None of the demographic parameters was significantly associated with adherence in univariate analyses. Nor was any association found between adherence and health literacy (Table 1). No significant association was found between adherence and having a preference for accepting responsibility for medical problem-solving, self-assessed HIV knowledge, awareness of CD4 count test name, result or target, or awareness of the HIV viral load test name or target (Table 2). In contrast, a preference for making choices, correct knowledge of HIV viral load, and a high score on the Intention to Adhere to HIV Treatment Scale were significantly associated with adherence in univariate analyses (Table 2). Similar results were obtained whether the measure of adherence was during the past month or during the past week (data not shown); hence, all further analyses used HAART adherence during the last month as the primary outcome.
Separate multivariate analyses were performed using each factor that was significantly associated with adherence on univariate analysis, including a preference for making choices, correct knowledge of HIV viral load, and high score on the Intention to Adhere to HIV Treatment Scale (Table 3), as well as factors that did not differ on univariate analysis but were important in our theoretic model (i.e. self-assessed knowledge scores and decision-making style). These analyses showed no association between adherence and self-assessed knowledge (model 1). Positive associations were found between adherence and a high intention score (model 2), correct reporting of HIV viral load (model 3), and a preference for having choices. No association was found between adherence and accepting responsibility (model 4). In model 5, which included all the factors of models 1–4, the only variable significantly associated with adherence was a high intention score. Respondents with a high intention score had 2.2 times higher odds of being adherent during the last month (95% confidence interval 1.1 to 4.3). The associations between wanting choices and correct knowledge of viral load results were no longer significant.
Results
The survey was distributed to 311 patients at two HIV clinics. Fifteen incomplete surveys were excluded from analysis. An additional 43 were excluded because the respondents were not on HAART. Nine were excluded because the respondents had started HAART too recently to measure adherence during the past month. Results from the remaining 244 questionnaires were included in this analysis (Fig 2).
(Enlarge Image)
Figure 2.
Flowchart for participant exclusion. HAART, highly active antiretroviral therapy.
Sixty-eight per cent of the patients were adherent during the last month. Table 1 shows the baseline characteristics of the study population with comparisons between adherent and nonadherent participants based on the primary outcome of adherence during the last month. The mean age of the participants was 52 years; 92% were male and more than 50% were Black. Sixty per cent had some college education and 70% had adequate functional health literacy. Sixty-two per cent reported having an HIV diagnosis for over 10 years. Seventy-nine per cent came from the VA site. The adherent and nonadherent groups did not differ significantly in terms of age, gender, race, education, health literacy, time since diagnosis, or site.
Differences in HIV Control Between Adherent and Nonadherent Subjects
As expected, adherent participants had significantly higher CD4 count than nonadherent participants (mean 528 vs. 431 cells/μL, respectively; P < 0.01), had significantly lower viral load (mean 1.8 vs. 2.3 log10 copies/mL, respectively; P < 0.001) and were significantly more likely to have undetectable viral load (97% vs. 81%, respectively; P < 0.0001). Overall, 217 patients (92%) had undetectable viral load.
Univariate Analyses
None of the demographic parameters was significantly associated with adherence in univariate analyses. Nor was any association found between adherence and health literacy (Table 1). No significant association was found between adherence and having a preference for accepting responsibility for medical problem-solving, self-assessed HIV knowledge, awareness of CD4 count test name, result or target, or awareness of the HIV viral load test name or target (Table 2). In contrast, a preference for making choices, correct knowledge of HIV viral load, and a high score on the Intention to Adhere to HIV Treatment Scale were significantly associated with adherence in univariate analyses (Table 2). Similar results were obtained whether the measure of adherence was during the past month or during the past week (data not shown); hence, all further analyses used HAART adherence during the last month as the primary outcome.
Multivariate Analyses
Separate multivariate analyses were performed using each factor that was significantly associated with adherence on univariate analysis, including a preference for making choices, correct knowledge of HIV viral load, and high score on the Intention to Adhere to HIV Treatment Scale (Table 3), as well as factors that did not differ on univariate analysis but were important in our theoretic model (i.e. self-assessed knowledge scores and decision-making style). These analyses showed no association between adherence and self-assessed knowledge (model 1). Positive associations were found between adherence and a high intention score (model 2), correct reporting of HIV viral load (model 3), and a preference for having choices. No association was found between adherence and accepting responsibility (model 4). In model 5, which included all the factors of models 1–4, the only variable significantly associated with adherence was a high intention score. Respondents with a high intention score had 2.2 times higher odds of being adherent during the last month (95% confidence interval 1.1 to 4.3). The associations between wanting choices and correct knowledge of viral load results were no longer significant.
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