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Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: a prospective study.
- Source :
-
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2004 Oct 15; Vol. 39 (8), pp. 1190-8. Date of Electronic Publication: 2004 Sep 27. - Publication Year :
- 2004
-
Abstract
- Background: We examined adherence to highly active antiretroviral therapy (HAART) in the homeless population, a population thought to be at high risk for poor adherence to therapy and for development of drug-resistant strains of human immunodeficiency virus (HIV).<br />Methods: We performed a 12-month prospective study of 148 persons receiving HAART who were identified in a stratified screening of the homeless and marginally housed. We sampled in lunch lines, shelters, and hotels in 3 neighborhoods of San Francisco, California. We used pill counts at unannounced home visits as the primary measure of adherence.<br />Results: Of 148 individuals sampled, 46 (31%) discontinued HAART during the study. Average adherence in the group of those who discontinued HAART was 51%, and 9% of these subjects had undetectable virus loads (i.e., <400 copies/mL) at the last follow-up visit. Predictors of discontinuation of therapy were depressive symptoms, injection drug use, African American ethnicity, and early poor adherence. Of 148 subjects, 102 (69%) continued to receive HAART throughout the study period. Average adherence in the group of those who continued to receive HAART was 74%, and 55% of these subjects had undetectable virus loads at the last follow-up visit. Predictors of lower average adherence in this group were African American ethnicity and use of crack cocaine; men who had sex with men had higher adherence.<br />Conclusions: One-third of homeless and marginally housed persons receiving HAART discontinued therapy during the follow-up period and would benefit from adherence interventions directed at sustaining therapy; two-thirds continued to receive therapy at adherence levels comparable to those found with other clinical populations.
- Subjects :
- Adult
Anti-HIV Agents therapeutic use
Female
HIV Infections epidemiology
Ill-Housed Persons psychology
Humans
Longitudinal Studies
Male
Middle Aged
Multivariate Analysis
Prospective Studies
San Francisco epidemiology
Anti-HIV Agents administration & dosage
Antiretroviral Therapy, Highly Active
HIV Infections drug therapy
Ill-Housed Persons statistics & numerical data
Patient Compliance statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6591
- Volume :
- 39
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
- Publication Type :
- Academic Journal
- Accession number :
- 15486844
- Full Text :
- https://doi.org/10.1086/424008