Gender Differences in Non-adherence Among Brazilian Patients Initiating Antiretroviral Therapy

Overview

Journal Clinics (Sao Paulo)

Publisher Elsevier

Specialty General Medicine

Date 2013 Jun 20

PMID 23778401

Citations 15

Authors

Palmira de Fatima Bonolo

Maria das Gracas Braga Ceccato

Gustavo Machado Rocha

Francisco de Assis Acurcio

Lorenza Nogueira Campos

Mark Drew Crosland Guimaraes

Affiliations

Soon will be listed here.

Abstract

Objective: We conducted a study to identify gender differences in factors associated with the first episode of non-adherence in the 12 months following the first antiretroviral prescription.

Methods: A concurrent prospective study of patients initiating antiretroviral therapy in Brazil was conducted from 2001-2002. The self-reported measurement of adherence was defined as an intake of less than 95% of the prescribed number of doses. Only the first occurrence of non-adherence was considered in this analysis. All analyses were stratified by gender. A Cox proportional hazard model was used to estimate the risk of non-adherence, and the time to non-adherence was estimated using the Kaplan-Meier method.

Results: The cumulative incidence of non-adherence was 34.6% (29.7% and 43.9% among men and women, respectively; p=0.010). Marital status (being married or in stable union; p=0.022), alcohol use in the month prior to the baseline interview (p=0.046), and current tobacco use (p=0.005) increased the risk of non-adherence among female participants only, whereas a self-reported difficulty with the antiretroviral treatment was associated with non-adherence in men only. For both men and women, we found that a longer time between the HIV test and first antiretroviral therapy prescription (p=0.028) also presented an increased risk of non-adherence.

Conclusions: In this cohort study, the incidence of non-adherence was 1.5 times greater among women compared to men. Our results reinforce the need to develop interventions that account for gender differences in public referral centers. Additionally, we emphasize that, to achieve and maintain appropriate adherence levels, it is important to understand the barriers to seeking and utilizing health care services.

Citing Articles

Factors associated with self-reported suboptimal antiretroviral adherence and limited retention in care among people living with HIV who attend a large ART clinic in Panama City, Panama.

Gabster A, Diaz Fernandez F, Pascale J, Orillac A, Moreno-Wynter S, Hall C PLoS One. 2024; 19(11):e0311048.

PMID: 39602419 PMC: 11602065. DOI: 10.1371/journal.pone.0311048.

Prevalence and Modifiable Factors for Holistic Non-Adherence in Renal Transplant Patients: A Cross-Sectional Study.

Torres-Gutierrez M, Burgos-Camacho V, Caamano-Jaraba J, Lozano-Suarez N, Garcia-Lopez A, Giron-Luque F Patient Prefer Adherence. 2023; 17:2201-2213.

PMID: 37701427 PMC: 10493132. DOI: 10.2147/PPA.S419324.

Treatment Adherence among HIV and TB Patients Using Single and Double Way Mobile Phone Text Messages: A Randomized Controlled Trial.

Kibu O, Siysi V, Albert Legrand S, Tanue E, Nsagha D J Trop Med. 2022; 2022:2980141.

PMID: 35996467 PMC: 9392638. DOI: 10.1155/2022/2980141.

HIV and Substance Use in Latin America: A Scoping Review.

Huff H, Carcamo P, Diaz M, Conklin J, Salvatierra J, Aponte R Int J Environ Res Public Health. 2022; 19(12).

PMID: 35742448 PMC: 9222977. DOI: 10.3390/ijerph19127198.

Examining adherence barriers among women with HIV to tailor outreach for long-acting injectable antiretroviral therapy.

Benning L, Mantsios A, Kerrigan D, Coleman J, Golub E, Blackstock O BMC Womens Health. 2020; 20(1):152.

PMID: 32711509 PMC: 7382076. DOI: 10.1186/s12905-020-01011-8.

References

Mocroft A, Gill M, Davidson W, Phillips A . Are there gender differences in starting protease inhibitors, HAART, and disease progression despite equal access to care?. J Acquir Immune Defic Syndr. 2000; 24(5):475-82. DOI: 10.1097/00126334-200008150-00013. View

Zigmond A, SNAITH R . The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983; 67(6):361-70. DOI: 10.1111/j.1600-0447.1983.tb09716.x. View

Applebaum A, Richardson M, Brady S, Brief D, Keane T . Gender and other psychosocial factors as predictors of adherence to highly active antiretroviral therapy (HAART) in adults with comorbid HIV/AIDS, psychiatric and substance-related disorder. AIDS Behav. 2008; 13(1):60-5. DOI: 10.1007/s10461-008-9441-x. View

Vosvick M, Martin L, Smith N, Jenkins S . Gender differences in HIV-related coping and depression. AIDS Behav. 2008; 14(2):390-400. DOI: 10.1007/s10461-008-9490-1. View

Azar M, Springer S, Meyer J, Altice F . A systematic review of the impact of alcohol use disorders on HIV treatment outcomes, adherence to antiretroviral therapy and health care utilization. Drug Alcohol Depend. 2010; 112(3):178-93. PMC: 2997193. DOI: 10.1016/j.drugalcdep.2010.06.014. View

Moore D, Zhang W, Yip B, Genebat M, Lima V, Montaner J . Non-medically supervised treatment interruptions among participants in a universally accessible antiretroviral therapy programme. HIV Med. 2009; 11(5):299-307. DOI: 10.1111/j.1468-1293.2009.00779.x. View

Webb M, Vanable P, Carey M, Blair D . Medication adherence in HIV-infected smokers: the mediating role of depressive symptoms. AIDS Educ Prev. 2009; 21(3 Suppl):94-105. DOI: 10.1521/aeap.2009.21.3_supp.94. View

Floridia M, Giuliano M, Palmisano L, Vella S . Gender differences in the treatment of HIV infection. Pharmacol Res. 2008; 58(3-4):173-82. DOI: 10.1016/j.phrs.2008.07.007. View

Kempf M, Pisu M, Dumcheva A, Westfall A, Michael Kilby J, Saag M . Gender differences in discontinuation of antiretroviral treatment regimens. J Acquir Immune Defic Syndr. 2009; 52(3):336-41. PMC: 2783854. DOI: 10.1097/QAI.0b013e3181b628be. View

10.

Crosland Guimaraes M, Rocha G, Campos L, de Freitas F, Gualberto F, Teixeira R . Difficulties reported by HIV-infected patients using antiretroviral therapy in Brazil. Clinics (Sao Paulo). 2008; 63(2):165-72. PMC: 2664217. DOI: 10.1590/s1807-59322008000200003. View

11.

Lazo M, Gange S, Wilson T, Anastos K, Ostrow D, Witt M . Patterns and predictors of changes in adherence to highly active antiretroviral therapy: longitudinal study of men and women. Clin Infect Dis. 2007; 45(10):1377-85. DOI: 10.1086/522762. View

12.

Bonolo P, Cesar C, Acurcio F, Ceccato M, de Padua C, Alvares J . Non-adherence among patients initiating antiretroviral therapy: a challenge for health professionals in Brazil. AIDS. 2005; 19 Suppl 4:S5-13. DOI: 10.1097/01.aids.0000191484.84661.2b. View

13.

Lima V, Harrigan R, Bangsberg D, Hogg R, Gross R, Yip B . The combined effect of modern highly active antiretroviral therapy regimens and adherence on mortality over time. J Acquir Immune Defic Syndr. 2009; 50(5):529-36. PMC: 3606956. DOI: 10.1097/QAI.0b013e31819675e9. View

14.

Duran S, Spire B, Raffi F, Walter V, Bouhour D, Journot V . Self-reported symptoms after initiation of a protease inhibitor in HIV-infected patients and their impact on adherence to HAART. HIV Clin Trials. 2001; 2(1):38-45. DOI: 10.1310/R8M7-EQ0M-CNPW-39FC. View

15.

Kyser M, Buchacz K, Bush T, Conley L, Hammer J, Henry K . Factors associated with non-adherence to antiretroviral therapy in the SUN study. AIDS Care. 2011; 23(5):601-11. DOI: 10.1080/09540121.2010.525603. View

16.

. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998; 28(3):551-8. DOI: 10.1017/s0033291798006667. View

17.

Kuyper L, Wood E, Montaner J, Yip B, OConnell J, Hogg R . Gender differences in HIV-1 RNA rebound attributed to incomplete antiretroviral adherence among HIV-Infected patients in a population-based cohort. J Acquir Immune Defic Syndr. 2004; 37(4):1470-6. DOI: 10.1097/01.qai.0000138379.39317.62. View

18.

Ortego C, Huedo-Medina T, Llorca J, Sevilla L, Santos P, Rodriguez E . Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS Behav. 2011; 15(7):1381-96. DOI: 10.1007/s10461-011-9942-x. View

19.

. 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR Recomm Rep. 1992; 41(RR-17):1-19. View

20.

Simoni J, Pantalone D, Plummer M, Huang B . A randomized controlled trial of a peer support intervention targeting antiretroviral medication adherence and depressive symptomatology in HIV-positive men and women. Health Psychol. 2007; 26(4):488-95. PMC: 4044097. DOI: 10.1037/0278-6133.26.4.488. View