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EMBARGOED FOR RELEASE: March 15, 2000
Social Support And Confidence Predict Medication Adherence For AIDS Patients
AIDS patients are more likely to follow newer, more complex medication schedules if they possess a network of friends and others to support them, according to researchers from the Medical College of Wisconsin. They reported their findings in the current issue of 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, Ph.D., 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 Memorial Lutheran Hospital's Infectious Disease Clinic. All 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 daily in specific sequences - can reduce HIV to undetectable levels and decrease death rates from AIDS. But slight or occasional deviations from the prescribed routine can allow the virus to rebound and become resistant to antiretroviral drugs.
Dr. Catz and colleagues report that 18 percent 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 others, 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.
Nonadherent patients also were more likely than adherent patients to report certain barriers to taking the medications, including that the treatment reminded them of their HIV status, that the instructions were too complicated to understand or to follow, and that they did not think the medications were helpful.
Both groups used similar strategies to help them follow the medication routines, including using mealtimes, bedtimes or other daily activities as reminders to take their medicines; storing them in a case that they carried everywhere; and questioning their health care provider.
"These findings highlight the need for interventions that help patients organize and manage their medication-taking routines, plan and problem solve how they will handle medication-taking in the context of their other life activities, use strategies to make complex regimens easier to recall, and consult with their health care providers when questions about regimens arise or when treatment side effects are encountered," said Dr. Catz.
The study was supported by a grant from the National Institute of Mental Health awarded to Jeffrey A. Kelly, Ph.D., as principal investigator. Dr. Kelly is director of CAIR and professor of psychiatry and behavioral medicine. Medical College of Wisconsin co researchers were Eric Benotsch, Ph.D., Laura Bogart, Ph.D., and Timothy L. McAuliffe, Ph.D.
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