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Heterogeneity among studies in rates of decline of ART adherence over time: Results from the MACH14 study
Filetype[PDF - 1.08 MB]


Details:
  • Corporate Authors:
    Multisite Adherence Collaboration in HIV 14 Investigators
  • Pubmed ID:
    24225904
  • 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
  • Document Type:
  • Collection(s):
  • Description:
    Objective

    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.

    Design

    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.

    Results

    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.

    Limitations

    Findings may not be generalizable to non-US populations or to patients not in clinical studies.

    Conclusions

    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.