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Olivieri-Mui B, Wilson I, Shi S, Montano M, McCarthy EP, Oh G, Kim DH. Geriatric Conditions Associated with Nonadherence to Antiretroviral Therapy Among Older People with HIV: The Importance of Frailty. AIDS Patient Care STDS 2022; 36:226-235. [PMID: 35687816 PMCID: PMC9242718 DOI: 10.1089/apc.2022.0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Poor compliance with medications is a growing concern in geriatric care and is increasingly more relevant among people living with HIV (PLWH) as they age. Our goal was to understand geriatric conditions associated with antiretroviral therapy (ART) nonadherence in a Medicare population of older PLWH. We analyzed Medicare data from PLWH aged 50 years or older who were continuously enrolled in fee-for-service Medicare from January 1, 2014 to June 30, 2015. Prevalent geriatric conditions (dementia, depression, falls, hip fracture, sensory deficits, osteoporosis, orthostatic hypotension, urinary incontinence, frailty) were identified in January 1, 2014-December 31, 2014. ART nonadherence was defined as <80% proportion of days covered (PDC) by at least two ART medications in January 1, 2015-June 30, 2015. We examined geriatric condition association with nonadherence using lowest Akaike Information Criterion multi-variate logistic models, controlling for age, sex, race, census region, substance use, Medicaid eligibility, and polypharmacy. Of 8778 PLWH, 23% (n = 2042) had <80% PDC. The average age was 60 years (standard deviation ±8), and >70% were males. In adjusted models, age was not associated with nonadherence, frailty status was the only geriatric condition associated with nonadherence [robust: reference, prefrail odds ratio (OR): 0.97, confidence interval (95% CI) 0.86-1.10, frail OR: 1.34 95% CI 1.11-1.61], and odds of nonadherence were lower for polypharmacy [OR: 0.48 (0.43-0.54)]. Our findings suggest that patient-centered care plans aimed at improving ART adherence among older PLWH would benefit from long-term surveillance; a deeper understanding of the role of frailty and polypharmacy, even at chronologically younger ages in PLWH.
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Affiliation(s)
- Brianne Olivieri-Mui
- The Roux Inst and Department of Health Sciences, Northeastern University, Boston, Massachusetts, USA.,The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA.,Address correspondence to: Brianne Olivieri-Mui, MPH, PhD, The Roux Inst and Department of Health Sciences, Northeastern University, 360 Huntington Avenue, 316a Robinson Hall, Boston, MA 02115, USA
| | - Ira Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Sandra Shi
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Monty Montano
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ellen P. McCarthy
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Gahee Oh
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
| | - Dae Hyun Kim
- The Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, Massachusetts, USA
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Foley L, Larkin J, Lombard-Vance R, Murphy AW, Hynes L, Galvin E, Molloy GJ. Prevalence and predictors of medication non-adherence among people living with multimorbidity: a systematic review and meta-analysis. BMJ Open 2021; 11:e044987. [PMID: 34475141 PMCID: PMC8413882 DOI: 10.1136/bmjopen-2020-044987] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES This systematic review aimed to describe medication non-adherence among people living with multimorbidity according to the current literature, and synthesise predictors of non-adherence in this population. METHODS A systematic review was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. PubMed, EMBASE, CINAHL and PsycINFO were searched for relevant articles published in English language between January 2009 and April 2019. Quantitative studies reporting medication non-adherence and/or predictors of non-adherence among people with two or more chronic conditions were included in the review. A meta-analysis was conducted with a subgroup of studies that used an inclusive definition of multimorbidity to recruit participants, rather than seeking people with specific conditions. Remaining studies reporting prevalence and predictors of non-adherence were narratively synthesised. RESULTS The database search produced 10 998 records and a further 75 were identified through other sources. Following full-text screening, 178 studies were included in the review. The range of reported non-adherence differed by measurement method, at 76.5% for self-report, 69.4% for pharmacy data, and 44.1% for electronic monitoring. A meta-analysis was conducted with eight studies (n=8949) that used an inclusive definition of multimorbidity to recruit participants. The pooled prevalence of non-adherence was 42.6% (95% CI: 34.0 - 51.3%, k=8, I2=97%, p<0.01). The overall range of non-adherence was 7.0%-83.5%. Frequently reported correlates of non-adherence included previous non-adherence and treatment-related beliefs. CONCLUSIONS The review identified a heterogeneous literature in terms of conditions studied, and definitions and measures of non-adherence used. Results suggest that future attempts to improve adherence among people with multimorbidity should determine for which conditions individuals require most support. The variable levels of medication non-adherence highlight the need for more attention to be paid by healthcare providers to the impact of multimorbidity on chronic disease self-management. PROSPERO REGISTRATION NUMBER CRD42019133849.
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Affiliation(s)
- Louise Foley
- School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - James Larkin
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Lombard-Vance
- Department of Psychology, National University of Ireland Maynooth, Maynooth, Ireland
| | - Andrew W Murphy
- Discipline of General Practice, National University of Ireland Galway, Galway, Ireland
- HRB Primary Care Clinical Trials Network Ireland, National University of Ireland Galway, Galway, Ireland
| | - Lisa Hynes
- Health Programmes, Croí Heart & Stroke Centre, Galway, Ireland
| | - Emer Galvin
- School of Pharmacy & Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Gerard J Molloy
- School of Psychology, National University of Ireland Galway, Galway, Ireland
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Risher KA, Kapoor S, Daramola AM, Paz-Bailey G, Skarbinski J, Doyle K, Shearer K, Dowdy D, Rosenberg E, Sullivan P, Shah M. Challenges in the Evaluation of Interventions to Improve Engagement Along the HIV Care Continuum in the United States: A Systematic Review. AIDS Behav 2017; 21:2101-2123. [PMID: 28120257 PMCID: PMC5843766 DOI: 10.1007/s10461-017-1687-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the United States (US), there are high levels of disengagement along the HIV care continuum. We sought to characterize the heterogeneity in research studies and interventions to improve care engagement among people living with diagnosed HIV infection. We performed a systematic literature search for interventions to improve HIV linkage to care, retention in care, reengagement in care and adherence to antiretroviral therapy (ART) in the US published from 2007-mid 2015. Study designs and outcomes were allowed to vary in included studies. We grouped interventions into categories, target populations, and whether results were significantly improved. We identified 152 studies, 7 (5%) linkage studies, 33 (22%) retention studies, 4 (3%) reengagement studies, and 117 (77%) adherence studies. 'Linkage' studies utilized 11 different outcome definitions, while 'retention' studies utilized 39, with very little consistency in effect measurements. The majority (59%) of studies reported significantly improved outcomes, but this proportion and corresponding effect sizes varied substantially across study categories. This review highlights a paucity of assessments of linkage and reengagement interventions; limited generalizability of results; and substantial heterogeneity in intervention types, outcome definitions, and effect measures. In order to make strides against the HIV epidemic in the US, care continuum research must be improved and benchmarked against an integrated, comprehensive framework.
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Affiliation(s)
- Kathryn A Risher
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA.
| | - Sunaina Kapoor
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alice Moji Daramola
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Gabriela Paz-Bailey
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jacek Skarbinski
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Doyle
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Kate Shearer
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - David Dowdy
- Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615N. Wolfe St, W6604, Baltimore, MD, 20205, USA
| | - Eli Rosenberg
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Patrick Sullivan
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Maunank Shah
- Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Borrego Y, Gómez-Fernández E, Jiménez R, Cantudo R, Almeida-González CV, Morillo R. Predictors of primary non-adherence to concomitant chronic treatment in HIV-infected patients with antiretroviral therapy. Eur J Hosp Pharm 2017; 25:127-131. [PMID: 31157006 DOI: 10.1136/ejhpharm-2016-001000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 11/21/2016] [Accepted: 01/16/2017] [Indexed: 12/28/2022] Open
Abstract
Objectives To identify the independent risk factors of primary non-adherence to chronic concomitant treatment in HIV-positive patients, and to measure primary and secondary non-adherence rates to chronic treatments, and secondary non-adherence to antiretroviral therapy and the prevalence of concomitant chronic diseases. Methods We conducted a retrospective study that included HIV-infected patients with antiretroviral treatmentwho attended the pharmaceutical care office between January and December 2012. The dependent variable was primary non-adherence to concomitant prescription drugs for chronic diseases. To know the predictors of concomitant primary non-adherence, we performed a univariate analysis and a multivariate binary logistic regression model to identify the independent predictors of primary non-adherence to co-medication. Results Out of 598 patients analysed, 333 patients had a new co-medication prescribed during the studied period. The number of comorbidities per patient was 2.3 and the patients were treated with an average of 3.4 drugs. The rates of primary and secondary non-adherence to co-medication were 8.4% and 44.4%, respectively. The co-occurrence of primary and secondary non-adherence was 24.9%. The number of comorbidities (p=0.001) and co-medications (p=0.001) was significantly higher in patients who had primary non-adherence to co-medication. Furthermore, there was a statistically significant relationship between primary non-adherence and patients treated with psychotropic drugs (p=0.03). The multivariate analysis showed the independent predictor of primary non-adherence to co-medication was the number of co-medications (p<0.001). Conclusion One-third of new concomitant medications prescribed to HIV-positive patients were never filled from the pharmacy. The number of co-medications was identified as a predictor of primary non-adherence to chronic concomitant treatment in HIV-infected population.
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Affiliation(s)
- Yolanda Borrego
- Department of Pharmacy, Hospital Universitario Nuestra Señora de Valme, Seville, Spain
| | | | - Rocío Jiménez
- Department of Pharmacy, Hospital Universitario Nuestra Señora de Valme, Seville, Spain
| | - Rosa Cantudo
- Department of Pharmacy, Hospital Universitario Nuestra Señora de Valme, Seville, Spain
| | | | - Ramón Morillo
- Department of Pharmacy, Hospital Universitario Nuestra Señora de Valme, Seville, Spain
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Holtzman CW, Brady KA, Yehia BR. Retention in care and medication adherence: current challenges to antiretroviral therapy success. Drugs 2015; 75:445-54. [PMID: 25792300 DOI: 10.1007/s40265-015-0373-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Health behaviors such as retention in HIV medical care and adherence to antiretroviral therapy (ART) pose major challenges to reducing new HIV infections, addressing health disparities, and improving health outcomes. Andersen's Behavioral Model of Health Service Use provides a conceptual framework for understanding how patient and environmental factors affect health behaviors and outcomes, which can inform the design of intervention strategies. Factors affecting retention and adherence among persons with HIV include patient predisposing factors (e.g., mental illness, substance abuse), patient-enabling factors (e.g., social support, reminder strategies, medication characteristics, transportation, housing, insurance), and healthcare environment factors (e.g., pharmacy services, clinic experiences, provider characteristics). Evidence-based recommendations for improving retention and adherence include (1) systematic monitoring of clinic attendance and ART adherence; (2) use of peer or paraprofessional navigators to re-engage patients in care and help them remain in care; (3) optimization of ART regimens and pharmaceutical supply chain management systems; (4) provision of reminder devices and tools; (5) general education and counseling; (6) engagement of peer, family, and community support groups; (7) case management; and (8) targeting patients with substance abuse and mental illness. Further research is needed on effective monitoring strategies and interventions that focus on improving retention and adherence, with specific attention to the healthcare environment.
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Affiliation(s)
- Carol W Holtzman
- ICAP, Columbia University Mailman School of Public Health, P.O. Box 13860, Maseru 100, Lesotho,
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