Background While combination antiretroviral therapy (cART) has revolutionised the course of HIV infection, a high level of adherence to cART is required to achieve the full mortality benefit. While a number of studies have investigated factors associated with non-adherence to cART, there has been considerable variability in the findings. In this study we set out to determine which personal, socioeconomic, treatment-related and disease-related factors are independently associated with adherence to ARV in an Australian sample of PLWH.
Methods Using data from the HIV futures six survey, an anonymous cross-sectional survey of PLWH conducted in 2009, we conducted bivariate and multivariate analyses to assess the association of factors with self-reported difficulty taking ARV. Chi-square and t tests were used for bivariate analysis. A two-step logistic regression modelling procedure based on backwards stepwise regression was used for multivariate analysis. Factors that demonstrated a significant association at α=0.2 in bivariate analysis were included in multivariate analysis.
Results We identified 75 variables within our data that were likely to be associated with difficulty taking ARV. 45 met multivariate analysis inclusion criteria. Factors found to be independently associated at a=0.05: younger age, alcohol and party drug use, diagnosis of mental health condition, poor or fair self-reported health, living in a regional centre, taking more than 1 ARV dose/day, experiencing adverse physical events in the last 12 months, health service discrimination in the last 2 years, using a nucleotide analogue reverse transcriptase inhibitor or protease inhibitor and specific attitudes: not believing in the benefits of ARV, concern about medication efficacy in the future and thinking that ARV tablets were an unwanted reminder of having HIV.
Conclusion The multitude of factors found to be independently associated with difficulty taking ARV reaffirms the dynamic nature of adherence behaviour and the ongoing importance of addressing adherence behaviour in the clinical management of PLWH.
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