August 11, 2003
Subjects brought their antiretroviral medications to the baseline visit, where they were given a medicine bottle with a microelectronic chip in the cap. Participants dispensed a two-week supply of their most complex medication into the bottle, and researchers told them the chip would record the date and time of each bottle opening. They were instructed to open the bottle containing the selected medication only when preparing to take a dose, and to remove only one dose at a time. Researchers also gathered demographic information (age, gender, ethnicity/race, education, housing accommodations and household composition, employment status, income, and relationship status) and drew blood specimens to be used to perform assays for CD4 count and HIV RNA (PCR) viral load.
At the week-two visit, participants turned in their bottle caps and recalled their pill-taking behavior over the previous three days, both HIV and psychotropic medication (if applicable). Researchers asked participants about doses missed and number of days they missed taking their medications over the study period, and questioned them about their adherence strategies.
Of the 45 participants who completed the study, mean age was 41, 79 percent were male, 49 percent were Caucasian, 43 percent were African-American, and 9 percent were Latino. Twenty five percent were employed, and education ranged from 23 percent not having completed high school to 25 percent with a college degree. Eighty-one percent were single, 24 percent had unstable or temporary housing, and 66 percent identified as gay or bisexual.
The authors pointed out that theirs was the first published study to systematically evaluate adherence to HIV antiretrovirals in persons with serious mental illness. In the study's small sample, the data suggested individuals with serious mental illness are able to adhere to antiretrovirals at levels similar to other HIV populations. "Consequently," the researchers wrote, "mental illness alone is not a reason to defer or deny treatment that is otherwise medically warranted." The authors cautioned, however, that a substantial number of participants displayed poor adherence.
"Further work," they concluded, "is needed to identify barriers to adherence that may be unique to persons with serious mental illness, which could then inform the development of interventions to help those struggling with adherence to achieve optimal treatment benefits."
AIDS Patient Care and STDs
04.03; Vol. 17; No. 4: P. 179-186; Glenn J. Wagner, Ph.D.; David E. Kanouse, Ph.D.; Paul Koegel, Ph.D.; Greer Sullivan, M.D., M.S.P.H.