Graduation Year

2008

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Nursing

Major Professor

Gail Powell-Cope, Ph.D.

Committee Member

Lois O. Gonzalez, Ph.D.

Committee Member

Stephen Luther, Ph.D.

Committee Member

Mary Webb, Ph.D.

Keywords

HIV/AIDS, Compliance, Medication, Antiretroviral therapy

Abstract

Background: Adherence to antiretroviral (ARV) medications in excess of 90-95% is necessary for optimal response to suppress HIV replication and to maintain and/or restore immune function. A number of interventions have been shown to improve ARV adherence, but no research has been conducted which evaluates proactive monitoring of pharmacy refill adherence and subsequent intervention when inadequate adherence is identified.

Purpose: The purpose of this project was to compare treatment response, pharmacy refill adherence and self-reported medication adherence between two groups of patients: those participating in an AIDS Drug Assistance Program (ADAP) and those participating in a Medicaid-funded medication access program. The ADAP served as a structured adherence intervention (SAI) based on procedural and administrative processes required by the state-managed program Additionally, covariates that can impact adherence were studied including utilization of adherence services and interventions and factors related to HIV disease, antiretroviral agents and sociodemographic factors.

Method: This retrospective comparative study examined secondary data to assess 424 patients who received clinical and pharmacy services at one treatment site in 2005.

Analysis: Logistic regression was performed to test the effects of the SAI on treatment response (CD4 and HIV RNA response), self-reported adherence, and pharmacy refill adherence while controlling for the covariates.

Results: Patients participating in the SAI demonstrated higher levels of both self-reported and pharmacy refill adherence compared to patients receiving usual care. Although patients participating in the SAI program demonstrated better virologic (HIV RNA) responses to HAART compared to patients receiving usual care, immunologic (CD4 lymphocyte) responses to HAART were not significantly different compared to subjects in the usual care program.

Conclusion/Discussion: This study provides information on the effects of a structured programmatic intervention on medication adherence and response to treatment and will be used to inform policy decision making at the local and State level.

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