Self-efficacy and adherence to Antiretroviral Therapy (ART) in HIV-infected Patients in New York City (NYC): Findings from the Medical Monitoring Project (MMP)

Background: 

High levels of adherence to antiretroviral therapy (ART) are required for effective suppression of HIV viral load, which predicts outcomes of therapy. We examine the prevalence of dosing adherence and whether self-efficacy is associated with adherence.

 

Methods:

A cross-sectional, probability sample of HIV-infected adults aged ≥18 years who received outpatient HIV care in NYC from 1/1/12-4/30/12 were interviewed for the CDC-funded Medical Monitoring Project (MMP).  Dosing adherence was defined as no skipped doses (past 3 days). Those currently receiving ART were analyzed using logistic regression. 

 

Results:

Of the 447 patients interviewed, 422 (98%) reported currently receiving ART.  Of these, 61% were male; median age was 48 years; 52% were black, 37% were Hispanic, 7% were white, and 3% were of other race/ethnicity.  Dosing adherence was reported by 86% and dosing non-adherence by 14%.   Extreme confidence in the ability to take all medication as directed compared to those who reported no confidence was associated with dosing adherence (91.3% vs 70% OR=4.5, 95%CI=1.10–18.53).  Drug use, depression, and other relevant variables were not associated with dose adherence.

Conclusion:

Approximately 1 in 7 HIV-infected individuals in this NYC sample reported suboptimal ART dosing adherence.  Those who reported that they were extremely confident that they would be able to take all or most of their medication as directed were less likely to be non-adherent.  Future research should examine barriers to adherence among those who are not confident in adhering to their medication and how those barriers can be reduced through self-efficacy skills building.