Heterogeneity among studies in rates of decline of ART adherence over time: Results from the MACH14 study
Published Date:Dec 15 2013
Source:J Acquir Immune Defic Syndr. 64(5):448-454.
Corporate Authors:Multisite Adherence Collaboration in HIV 14 Investigators
Antiretroviral Therapy, Highly Active
Highly Active Antiretroviral Therapy
Human Immunodeficiency Virus
Pubmed Central ID:PMC4212649
Funding:2R01NR04749/NR/NINR NIH HHS/United States
AI069419/AI/NIAID NIH HHS/United States
CC02-SD-003/CC/ODCDC CDC HHS/United States
CC99-SD-003/CC/ODCDC CDC HHS/United States
D43 TW001277/TW/FIC NIH HHS/United States
K02 DA017277/DA/NIDA NIH HHS/United States
K23MH01862/MH/NIMH NIH HHS/United States
K24 MH092242/MH/NIMH NIH HHS/United States
K24 RR020300/RR/NCRR NIH HHS/United States
M01 RR000054/RR/NCRR NIH HHS/United States
MH01584/MH/NIMH NIH HHS/United States
MH54907/MH/NIMH NIH HHS/United States
MH58986/MH/NIMH NIH HHS/United States
NIH/NIAID AI38858/PHS HHS/United States
P01 DK045734/DK/NIDDK NIH HHS/United States
P01 MH49548/MH/NIMH NIH HHS/United States
P30 AI042853/AI/NIAID NIH HHS/United States
R01 AI41413/AI/NIAID NIH HHS/United States
R01 DA015679/DA/NIDA NIH HHS/United States
R01 DA13826/DA/NIDA NIH HHS/United States
R01 MH083595/MH/NIMH NIH HHS/United States
R01 MH092238/MH/NIMH NIH HHS/United States
R01 MH61173/MH/NIMH NIH HHS/United States
R01DA015679/DA/NIDA NIH HHS/United States
R01DA11869/DA/NIDA NIH HHS/United States
R01DA15215/DA/NIDA NIH HHS/United States
R01MH068197/MH/NIMH NIH HHS/United States
R01MH078773/MH/NIMH NIH HHS/United States
R01MH61695/MH/NIMH NIH HHS/United States
R01NR04749/NR/NINR NIH HHS/United States
R21 MH073420/MH/NIMH NIH HHS/United States
RC4 AG039072/AG/NIA NIH HHS/United States
To use electronic drug monitoring to determine if adherence to HIV antiretroviral therapy changes over time, whether changes are linear, and how the declines vary by study.
We conducted a longitudinal study of pooled data from 11 different studies of HIV infected adults using antiretroviral therapy. The main outcome was antiretroviral therapy adherence (percent of prescribed doses taken) measured by electronic drug monitoring. We modeled and compared changes in adherence over time using repeated measures linear mixed effects models and generalized additive mixed models. Indicator variables were used to examine the impact of individual studies, and the variation across studies was evaluated using study-specific parameter estimates calculated by using interaction terms of study and time.
The mean age of the subjects was 41 years, 35% were female, most had high school education or less, and 46% were African-American. In generalized additive mixed models, adherence declined over time. The generalized additive mixed models further suggested that the decline was non-linear, and in both sets of models there was considerable study-to-study variability in how adherence changed over time.
Findings may not be generalizable to non-US populations or to patients not in clinical studies.
Although overall antiretroviral therapy adherence declined with time, not all studies showed declines, and a number of patterns of change were seen. Studies that identify clinical and organizational factors associated with these different patterns are needed. Models of changes in adherence with time should take account of possible non-linear effects.
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