The 130th Annual Meeting of APHA

Abstract #46768

Sharon B. Mannheimer, MD¹, Margaret E. Perkins, PhD², Jamye L Ford², Nancy I. Holson, MPH², Beverly Diamond, DSW³, Sally Findley, PhD⁴, and Wafaa El-Sadr, MD, MPH, MPA⁵. (1) Harlem Hospital Center, Columbia University College of Physicians and Surgeons, 506 Lenox Avenue rm 3101-A, New York, NY 10037, (212)939-2948, sbm20@columbia.edu, (2) Department of Infectious Diseases, Harlem Hospital, 506 Lenox Ave., New York, NY 10037, (3) Irving Center for Clinical Research, Columbia University, 630 W 168th St, New York, NY 10032, (4) Joseph L. Mailman School of Public Health, Columbia University, 600 West 168th Street, Fourth floor, New York, NY 10032, (5) Division of Infectious Diseases, Harlem Hospital Center, 506 Lenox Ave., Rm. 3101-A, New York, NY 10037

Background. Existing methods to measure adherence to therapy are limited. We compared adherence estimation by staging based on a transtheoretical model (TTM) with a standard 3 day self-report. Methods. Participants (Pts) enrolled in an adherence study from an inner city clinic were staged for intention to adhere to antiretroviral therapy(ART). TTM stages 1-3 were nonadherent to ART. Stages 4-5 were taking ART regularly for one week or 6 months respectively and defined as staging adherent (AdhStage). Adherence was also measured by three day self-report and adherent defined as taking >90% of doses(Adh3day). Results. Of the 180 pts eligible for ART at baseline, 56% were woman, 77% were African- American, 17% Latino and 78% on public assistance. 75% pts were adherent by AdhStage and 63% by Adh3day; 57% by both methods. There was a significant correlation between the two methods; r=.629 (p<.001).A nondetectable HIV RNA was associated with both AdhStage (p<.001) and Adh3day (p=.01). Having a CD4 cell >200 was associated with pts aherent by staging(p=.01)but was not associated with pts who were Adh3day(p=.42).Pts who were homeless (p=.004), depressed (p=.02) and a history of psychiatric hospitalization (p=.03) were less likely to be AdhStage by univariate analysis. None of these variables were associated with Adh3day. Latinos were more likely to be adherent by 3 day self-report (p=.03) but not by Adhstage (p=.40). Conclusion. Although there was overall correlation between the two adherence methods, important psychosocial factors were identified as being barriers to AdhStage but not Adh3day.

Learning Objectives:

• Participants will learn to evaluate two methods of assessing adherence to antiretroviral therapy and assess their limitations.
• An outcome will be that participants will be able to discuss different methods for adherence estimation and the psychosocial variables associated with adherence.
• The learning objective is to be able to evaluate methods for assessing adherence , identifying problems with the methodology. They will be able to discuss how different methods give different results.

Keywords: Adherence, HIV/AIDS

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.