Social Support and Confidence Predict AIDS Patient's Adherence to Complex Medication Regimens

AIDS patients are more likely to follow the complex new medication schedules if they have a strong network of friends and others to support them, according to researchers from the Medical College of Wisconsin.

They reported their findings in an article entitled, Patterns, Correlates, and Barriers to Medication Adherence Among Persons Prescribed New Treatments for HIV Disease in the March, 2000 issue of the journal Health Psychology.

"Our findings suggest that patients with limited emotional support should receive mental health and support services not only to improve psychological functioning but also, potentially, to enhance treatment adherence," said lead author Sheryl L. Catz, PhD, Assistant Professor of Psychiatry and Behavioral Medicine.

"Interventions that enhance a persons' perceived confidence in adhering to treatment regimens also seem particularly important, especially at the time when the therapy is initiated."

Researchers from the Medical College's Center for AIDS Intervention Research (CAIR) interviewed 72 Milwaukee-area AIDS patients at Froedtert Hospital's Infectious Disease Clinic. All of the study participants were taking three or more antiretroviral medications, including a protease inhibitor, as part of a "highly active antiretroviral therapy" (HAART) regimen. These regimens -- which sometimes require that 20 or more pills be taken every day in very specific sequences -- can reduce HIV to undetectable levels and decrease death rates from AIDS. But even a slight or occasional deviation from the prescribed medication routine can allow the virus to rebound and become resistant to antiretroviral drugs.

Dr. Catz and colleagues report that 18% of the patients were "nonadherent" -- defined as having missed at least one dose of the HAART regimen per week. Nonadherent patients were more depressed than those who stuck to the regimen. They reported more side effects, had lower confidence in their ability to follow the medication routine, and reported less support from friends and others.

When the researchers examined which of these factors independently predicted adherence, only patients' confidence and their perceptions of social support remained significant. More of the nonadherent patients reported barriers to taking the medications: the treatment reminded them of their HIV status; the instructions were too complicated; they did not think the medications were helpful.

Both groups of patients used similar kinds of strategies to help them follow the medication routines, including using mealtimes, bedtimes or other daily activities as reminders to take their medicines; storing the medications in a case that they carried everywhere; and communicating with their health care provider.

"These findings highlight the need for interventions that help patients to organize and manage their medication-taking routines, to plan how they will handle medication-taking in the context of their other life activities, to use strategies to make complex regimens easier to recall, and to consult with their health care providers when questions about regimens arise or when they experience treatment side effects" said Dr. Catz.

The study was supported by a grant from the National Institute of Mental Health awarded to Jeffrey A. Kelly, PhD, Director of CAIR and Professor of Psychiatry and Behavioral Medicine. Medical College of Wisconsin co-researchers were Eric Benotsch, PhD, Laura Bogart, PhD, and Timothy L. McAuliffe, PhD.

MCW Health News presents up-to-date information on patient care and medical research by the physicians of the Medical College of Wisconsin.