Factors Associated with Antiretroviral Therapy Adherence among Transgender Women Receiving HIV Medical Care in the United States

Abstract

Purpose: We examined factors associated with antiretroviral therapy (ART) adherence among transgender women living with HIV (TWLWH). Methods: We used combined data from the 2009 to 2013 cycles of Medical Monitoring Project, an HIV surveillance system designed to produce nationally representative estimates of the characteristics of HIV-infected adults receiving HIV medical care in the United States. Rao-Scott chi-square tests and multivariable logistic regression were used to identify factors associated with dose adherence (defined as taking 100% of prescribed ART doses in the past 3 days). Results: Among TWLWH who reported current ART use, an estimated 80.5% self-reported dose adherence. Multivariable factors independently associated with lower (<100%) dose adherence were younger age (30-39 vs. 40 and over), not having health insurance coverage, depression, lower self-efficacy to take medication as prescribed, and having greater than one daily ART dose. Conclusion: Our findings suggest several ways to potentially improve ART adherence of TWLWH including tailoring efforts to address the needs of TWLWH under age 40, increasing access to health insurance coverage, addressing mental health morbidities, building skills to improve medication adherence self-efficacy, and simplifying ART regimens when possible.