Barriers to and facilitators of HIV-positive patients' adherence to antiretroviral treatment regimens.

  • Meade C
  • Hansen N
  • Kochman A
 et al. 
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Abstract: HIV is a chronic, life-threatening illness that necessitates regular and consistent medical care. Childhood sexual abuse (CSA) is a common experience among HIV-positive adults and may interfere with treatment utilization. This study examined rates and correlates of treatment utilization among HIV-positive adults with CSA enrolled in a coping intervention trial in New York City. The baseline assessment included measures of treatment utilization, mental health, substance abuse, and other psychosocial factors. In 20022004, participants (50% female, 69% African-American, M=42.36.8 years old) were recruited. Nearly all (99%) received HIV medical care. However, 20% had no outpatient visits and 24% sought emergency services in the past 4 months. Among 184 participants receiving antiretroviral therapy (ART), 22% were less than 90% adherent in the past week. In a multivariable logistic regression model, no outpatient treatment was associated with African American race (AOR=3.46 1.428.40), poor social support (AOR=1.59 1.032.45), and abstinence from illicit drug use (AOR=0.37 0.160.85). Emergency service utilization was associated with HIV symptoms (AOR=2.30 1.224.35), binge drinking (AOR=2.92 (1.187.24)), and illicit drug use (AOR=1.98 1.023.85). Poor medication adherence was associated with trauma symptoms (AOR=2.64 1.076.75) and poor social support (AOR=1.82 1.092.97). In sum, while participants had access to HIV medical care, a sizable minority did not adhere to recommended guidelines and thus may not be benefiting optimally from treatment. Interventions targeting HIV-positive adults with CSA histories may need to address trauma symptoms, substance abuse, and poor social support that interfere with medical treatment utilization and adherence.

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  • Christina S Meade

  • Nathan B Hansen

  • Arlene Kochman

  • Kathleen J Sikkema

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