A Longitudinal Analysis of Daily Pill Burden and Likelihood of Optimal Adherence to Antiretroviral Therapy Among People Living With HIV Who Use Drugs

Nur Afiqah Mohd Salleh; Lindsey Richardson; Thomas Kerr; Jean Shoveller; Julio Montaner; Adeeba Kamarulzaman; M. J. Milloy

doi:10.1097/ADM.0000000000000403

A Longitudinal Analysis of Daily Pill Burden and Likelihood of Optimal Adherence to Antiretroviral Therapy Among People Living With HIV Who Use Drugs

Nur Afiqah Mohd Salleh, Lindsey Richardson, Thomas Kerr, Jean Shoveller, Julio Montaner, Adeeba Kamarulzaman, M. J. Milloy

Résultat de recherche: Article › examen par les pairs

12 Citations (Scopus)

Résumé

Objectives: Among people living with HIV (PLWH), high levels of adherence to prescribed antiretroviral therapy (ART) is required to achieve optimal treatment outcomes. However, little is known about the effects of daily pill burden on adherence amongst PLWHwho use drugs. We sought to investigate the association between daily pill burden and adherence to ARTamong members of this key population in Vancouver, Canada. Methods: We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services study, a long-running communityrecruited cohort of PLWH who use illicit drugs linked to comprehensive HIV clinical records. The longitudinal relationship between daily pill burden and the odds of ≥95% adherence to ART among ART-exposed individuals was analyzed using multivariable generalized linear mixed-effects modeling, adjusting for sociodemographic, behavioural, and structural factors linked to adherence. Results: Between December 2005 and May 2014, the study enrolled 770 ART-exposed participants, including 257 (34%) women, with a median age of 43 years. At baseline, 437 (56.7%) participants achieved ≥95% adherence in the previous 180 days. Among all interview periods, the median adherence was 100% (interquartile range 71%-100%). In a multivariable model, a greater number of pills per day was negatively associated with ≥95% adherence (adjusted odds ratio [AOR] 0.87 per pill, 95% confidence interval [CI] 0.84-0.91). Further analysis showed that once-a-day ART regimens were positively associated with optimal adherence (AOR 1.39, 95% CI 1.07-1.80). Conclusions: In conclusion, simpler dosing demands (ie, fewer pills and once-a-day single tablet regimens) promoted optimal adherence among PLWH who use drugs. Our findings highlight the need for simpler dosing to be encouraged explicitly for PWUD with multiple adherence barriers.

Langue d'origine	English
Pages (de-à)	308-314
Nombre de pages	7
Journal	Journal of Addiction Medicine
Volume	12
Numéro de publication	4
DOI	https://doi.org/10.1097/ADM.0000000000000403
Statut de publication	Published - juill. 1 2018
Publié à l'externe	Oui

Note bibliographique

Funding Information:
Conflicts of interest: NAMS’ postgraduate studies at the University of British Columbia (UBC) are funded by the Malaysian Ministry of Higher Education and University of Malaya, Malaysia. LR is supported by a New Investigator Award from CIHR and a MSFHR Scholar Award. TK is the co-director of the British Columbia Centre of Substance Use (BCCSU) at the British Columbia Centre for Excellence in HIV/AIDS, Professor in the Department of Medicine at UBC (Division of AIDS), and also Associate Faculty, School of Population & Public Health (SPPH), UBC. JS is the Director of Epidemiology & Population Health and the Drug Treatment Program at the British Columbia Centre for Excellence in HIV/AIDS, and also a Professor at SPPH, UBC. JM is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (No. 1DP1DA026182) from the National Institute of Drug Abuse at the US National Institutes of Health. He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief, UNICEF, UBC, Simon Fraser University, Providence Health Care and Vancouver Coastal Health Authority. A.K. is the Dean of the Faculty of Medicine, University of Malaya. M-JM is supported in part by the US National Institutes of Health (R01-DA021525), a Scholar Award from the Michael Smith Foundation for Health Research (MSFHR), and a New Investigator Award from the Canadian Institutes of Health Researcy (CIHR). His institution has received an unstructured gift from NG Biomed Ltd. to support his research.

Funding Information:
Funding: This study was supported by a research grant from the US National Institutes of Health (R01-DA021525).

Publisher Copyright:
Copyright © 2018 American Society of Addiction Medicine.

ASJC Scopus Subject Areas

Psychiatry and Mental health
Pharmacology (medical)

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10.1097/ADM.0000000000000403

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title = "A Longitudinal Analysis of Daily Pill Burden and Likelihood of Optimal Adherence to Antiretroviral Therapy Among People Living With HIV Who Use Drugs",

abstract = "Objectives: Among people living with HIV (PLWH), high levels of adherence to prescribed antiretroviral therapy (ART) is required to achieve optimal treatment outcomes. However, little is known about the effects of daily pill burden on adherence amongst PLWHwho use drugs. We sought to investigate the association between daily pill burden and adherence to ARTamong members of this key population in Vancouver, Canada. Methods: We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services study, a long-running communityrecruited cohort of PLWH who use illicit drugs linked to comprehensive HIV clinical records. The longitudinal relationship between daily pill burden and the odds of ≥95% adherence to ART among ART-exposed individuals was analyzed using multivariable generalized linear mixed-effects modeling, adjusting for sociodemographic, behavioural, and structural factors linked to adherence. Results: Between December 2005 and May 2014, the study enrolled 770 ART-exposed participants, including 257 (34%) women, with a median age of 43 years. At baseline, 437 (56.7%) participants achieved ≥95% adherence in the previous 180 days. Among all interview periods, the median adherence was 100% (interquartile range 71%-100%). In a multivariable model, a greater number of pills per day was negatively associated with ≥95% adherence (adjusted odds ratio [AOR] 0.87 per pill, 95% confidence interval [CI] 0.84-0.91). Further analysis showed that once-a-day ART regimens were positively associated with optimal adherence (AOR 1.39, 95% CI 1.07-1.80). Conclusions: In conclusion, simpler dosing demands (ie, fewer pills and once-a-day single tablet regimens) promoted optimal adherence among PLWH who use drugs. Our findings highlight the need for simpler dosing to be encouraged explicitly for PWUD with multiple adherence barriers. ",

author = "Salleh, {Nur Afiqah Mohd} and Lindsey Richardson and Thomas Kerr and Jean Shoveller and Julio Montaner and Adeeba Kamarulzaman and Milloy, {M. J.}",

note = "Funding Information: Conflicts of interest: NAMS{\textquoteright} postgraduate studies at the University of British Columbia (UBC) are funded by the Malaysian Ministry of Higher Education and University of Malaya, Malaysia. LR is supported by a New Investigator Award from CIHR and a MSFHR Scholar Award. TK is the co-director of the British Columbia Centre of Substance Use (BCCSU) at the British Columbia Centre for Excellence in HIV/AIDS, Professor in the Department of Medicine at UBC (Division of AIDS), and also Associate Faculty, School of Population & Public Health (SPPH), UBC. JS is the Director of Epidemiology & Population Health and the Drug Treatment Program at the British Columbia Centre for Excellence in HIV/AIDS, and also a Professor at SPPH, UBC. JM is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (No. 1DP1DA026182) from the National Institute of Drug Abuse at the US National Institutes of Health. He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President{\textquoteright}s Emergency Plan for AIDS Relief, UNICEF, UBC, Simon Fraser University, Providence Health Care and Vancouver Coastal Health Authority. A.K. is the Dean of the Faculty of Medicine, University of Malaya. M-JM is supported in part by the US National Institutes of Health (R01-DA021525), a Scholar Award from the Michael Smith Foundation for Health Research (MSFHR), and a New Investigator Award from the Canadian Institutes of Health Researcy (CIHR). His institution has received an unstructured gift from NG Biomed Ltd. to support his research. Funding Information: Funding: This study was supported by a research grant from the US National Institutes of Health (R01-DA021525). Publisher Copyright: Copyright {\textcopyright} 2018 American Society of Addiction Medicine.",

year = "2018",

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doi = "10.1097/ADM.0000000000000403",

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AU - Salleh, Nur Afiqah Mohd

AU - Richardson, Lindsey

AU - Kerr, Thomas

AU - Shoveller, Jean

AU - Montaner, Julio

AU - Kamarulzaman, Adeeba

AU - Milloy, M. J.

N1 - Funding Information: Conflicts of interest: NAMS’ postgraduate studies at the University of British Columbia (UBC) are funded by the Malaysian Ministry of Higher Education and University of Malaya, Malaysia. LR is supported by a New Investigator Award from CIHR and a MSFHR Scholar Award. TK is the co-director of the British Columbia Centre of Substance Use (BCCSU) at the British Columbia Centre for Excellence in HIV/AIDS, Professor in the Department of Medicine at UBC (Division of AIDS), and also Associate Faculty, School of Population & Public Health (SPPH), UBC. JS is the Director of Epidemiology & Population Health and the Drug Treatment Program at the British Columbia Centre for Excellence in HIV/AIDS, and also a Professor at SPPH, UBC. JM is supported by the British Columbia Ministry of Health and through an Avant-Garde Award (No. 1DP1DA026182) from the National Institute of Drug Abuse at the US National Institutes of Health. He has also received financial support from the International AIDS Society, United Nations AIDS Program, World Health Organization, National Institutes of Health Research-Office of AIDS Research, National Institute of Allergy & Infectious Diseases, The United States President’s Emergency Plan for AIDS Relief, UNICEF, UBC, Simon Fraser University, Providence Health Care and Vancouver Coastal Health Authority. A.K. is the Dean of the Faculty of Medicine, University of Malaya. M-JM is supported in part by the US National Institutes of Health (R01-DA021525), a Scholar Award from the Michael Smith Foundation for Health Research (MSFHR), and a New Investigator Award from the Canadian Institutes of Health Researcy (CIHR). His institution has received an unstructured gift from NG Biomed Ltd. to support his research. Funding Information: Funding: This study was supported by a research grant from the US National Institutes of Health (R01-DA021525). Publisher Copyright: Copyright © 2018 American Society of Addiction Medicine.

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N2 - Objectives: Among people living with HIV (PLWH), high levels of adherence to prescribed antiretroviral therapy (ART) is required to achieve optimal treatment outcomes. However, little is known about the effects of daily pill burden on adherence amongst PLWHwho use drugs. We sought to investigate the association between daily pill burden and adherence to ARTamong members of this key population in Vancouver, Canada. Methods: We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services study, a long-running communityrecruited cohort of PLWH who use illicit drugs linked to comprehensive HIV clinical records. The longitudinal relationship between daily pill burden and the odds of ≥95% adherence to ART among ART-exposed individuals was analyzed using multivariable generalized linear mixed-effects modeling, adjusting for sociodemographic, behavioural, and structural factors linked to adherence. Results: Between December 2005 and May 2014, the study enrolled 770 ART-exposed participants, including 257 (34%) women, with a median age of 43 years. At baseline, 437 (56.7%) participants achieved ≥95% adherence in the previous 180 days. Among all interview periods, the median adherence was 100% (interquartile range 71%-100%). In a multivariable model, a greater number of pills per day was negatively associated with ≥95% adherence (adjusted odds ratio [AOR] 0.87 per pill, 95% confidence interval [CI] 0.84-0.91). Further analysis showed that once-a-day ART regimens were positively associated with optimal adherence (AOR 1.39, 95% CI 1.07-1.80). Conclusions: In conclusion, simpler dosing demands (ie, fewer pills and once-a-day single tablet regimens) promoted optimal adherence among PLWH who use drugs. Our findings highlight the need for simpler dosing to be encouraged explicitly for PWUD with multiple adherence barriers.

AB - Objectives: Among people living with HIV (PLWH), high levels of adherence to prescribed antiretroviral therapy (ART) is required to achieve optimal treatment outcomes. However, little is known about the effects of daily pill burden on adherence amongst PLWHwho use drugs. We sought to investigate the association between daily pill burden and adherence to ARTamong members of this key population in Vancouver, Canada. Methods: We used data from the AIDS Care Cohort to Evaluate Exposure to Survival Services study, a long-running communityrecruited cohort of PLWH who use illicit drugs linked to comprehensive HIV clinical records. The longitudinal relationship between daily pill burden and the odds of ≥95% adherence to ART among ART-exposed individuals was analyzed using multivariable generalized linear mixed-effects modeling, adjusting for sociodemographic, behavioural, and structural factors linked to adherence. Results: Between December 2005 and May 2014, the study enrolled 770 ART-exposed participants, including 257 (34%) women, with a median age of 43 years. At baseline, 437 (56.7%) participants achieved ≥95% adherence in the previous 180 days. Among all interview periods, the median adherence was 100% (interquartile range 71%-100%). In a multivariable model, a greater number of pills per day was negatively associated with ≥95% adherence (adjusted odds ratio [AOR] 0.87 per pill, 95% confidence interval [CI] 0.84-0.91). Further analysis showed that once-a-day ART regimens were positively associated with optimal adherence (AOR 1.39, 95% CI 1.07-1.80). Conclusions: In conclusion, simpler dosing demands (ie, fewer pills and once-a-day single tablet regimens) promoted optimal adherence among PLWH who use drugs. Our findings highlight the need for simpler dosing to be encouraged explicitly for PWUD with multiple adherence barriers.

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A Longitudinal Analysis of Daily Pill Burden and Likelihood of Optimal Adherence to Antiretroviral Therapy Among People Living With HIV Who Use Drugs

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