Factors Associated With Adherence to Highly Active Antiretroviral Therapy in Homeless or Unstably Housed Adults Living With HIV

Scott W. Royal, Daniel P. Kidder, Satyendra Patrabansha, Richard J. Wolitski, David R. Holtgrave, Angela Aidala, Sherri Pals, and Ron Stall

April 2009

The purpose of the study is to investigate adherence to highly active antiretroviral therapy (HAART) in persons living with HIV/AIDS (PLWHA) who are homeless or unstably housed.  Using baseline data and controlling for gender, race, age, and education, the researchers examined associations between self-reported two- and seven-day adherence and access to healthcare, mental health, substance use, and attitudes toward HIV medical therapy.  Of the 644 participants, 358 (55%) were currently on HAART. For two-day adherence, 280 (78%) reported missing no prescribed doses (100% adherence), and for seven-day adherence, 291 (81%) reported 90-100% adherence.  Logistic regression analyses indicated being younger, not having health insurance, and drug use were associated with missing doses. Scoring lower on SF-36 mental component summary scale and having greater risk of depression and stress were also associated with poorer adherence for both two- and seven-day outcomes. Negative attitudes toward HIV treatment were also associated with lower adherence.  The researchers conclude that comprehensive models of HIV care that include a continuum of medical and social services are essential for treating this population.

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