JAC Advance Access originally published online on July 14, 2009
Journal of Antimicrobial Chemotherapy 2009 64(3):599-606; doi:10.1093/jac/dkp232
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Original research |
Factors associated with non-adherence to long-term highly active antiretroviral therapy: a 10 year follow-up analysis with correction for the bias induced by missing data
1 INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France 2 Université Aix Marseille, IRD, UMR-S912, Marseille, France 3 ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, 23 rue Stanislas Torrents, 13006 Marseille, France 4 Department of Infectious and Tropical Diseases, Hôtel-Dieu, 1 Place Alexis Ricordeau, 44035 Nantes Cedex 01, France 5 Department of Infectious and Tropical Diseases, Hôpital Gui de Chauliac, 80 Avenue Augustin Fliche, 34295 Montpellier Cedex 5, France 6 Department of Infectious and Tropical Diseases, Hôpital de l'Archet 1, 151 route Saint-Antoine de Ginestière, BP 3079, 06202 Nice Cedex 3, France 7 Department of Infectious and Tropical Diseases, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75877 Paris Cedex 18, France
Received 20 February 2009; returned 9 April 2009; revised 8 June 2009; accepted 14 June 2009
* Corresponding author. ORS PACA/INSERM U912, 23 rue Stanislas Torrents, 13006 Marseille, France. Tel: +33-4-96-10-28-80; Fax: +33-4-96-10-28-99; E-mail: camelia.protopopescu{at}inserm.fr
Objectives: The aim of this study was to identify factors associated with non-adherence over a 10 year follow-up of the APROCO-COPILOTE cohort during the maintenance phase of highly active antiretroviral therapy (HAART).
Methods: Overall, 1010 patients participated in this analysis, each having had at least 12 months of follow-up after HAART initiation and at least one self-reported adherence measure available during the follow-up period (month 12–month 120). Data collection was based on clinical records and self-administered questionnaires that gathered patients' psychosocial characteristics and experience with HIV disease and treatment. First, a generalized estimating equations (GEE) model was used to identify non-adherence predictors. Secondly, a Heckman two-stage approach was used in order to account for missing data bias and to measure the extent to which this could affect the results of the first model.
Results: Non-adherent behaviour was reported by 747 patients (2070 visits). After correcting for the bias due to missing data, non-adherence was independently associated with side effects, having a three times or more daily dosing regimen, experience of being at clinical stage B/C and being diagnosed as HIV-positive for <6 months. Non-adherence was more likely among patients who were younger, had children, were born in the European Union, had depressive symptoms, consumed alcohol daily and declared a lack of support from their main partner. Adjusting for missing outcome data changed the pattern of predictors.
Conclusions: Reasons for non-adherence depended on both psychosocial conditions and treatment-related characteristics. To improve long-term patient outcomes for those at risk of adherence failure, tailor-made patient-specific psychosocial interventions and regimen-based strategies with improved tolerance need to be implemented.
Keywords: HIV , ARV , HAART , self-reports , selection models , Heckman two-step
Members are listed in the Acknowledgements section.