Abstract #188  -  Non-adherence pattern to antiretroviral therapy among immigrants from low resources countries, attending a reference center in Rome.
Authors:   Presenting Author:   Dr Adriana Ammassari - National Institute for Infectious Diseases
Additional Authors:  Psy Paola Pierro, MD Adriana Ammassari, MD Maria Paola Trotta, MD Pietro Sette, MD Maria Letizia Giancola, Psy Marina Giulianelli, MD Andrea Antinori, MD Mauro  Zaccarelli,
Aim: Background. The number of HIV patients immigrant from low resources countries is progressively increasing in western Europe. The management of antiretroviral treatment in these patients requires understanding of different behaviors towards HIV infection and socio-cultural attitudes. In order to assess the degree and character of non-adherence to the prescribed treatment, we analyzed the data collected from questionnaires administered to patients attending our reference center in Rome, comparing immigrant with Italian patients.
Method / Issue: Methods. All patients attending the center are involved in a routine program including a brief self-reported adherence questionnaire, together with collection of behavioral data. Counseling for HIV infection is routinely provided at each visit. Physicians, psychologist, social workers and nursing staff are involved in supporting patients reporting inadequate level of adherence or requiring socio-psychological support. A preliminary analysis of data collected is reported.
Results / Comments: Results. Between 2007-2008, 790 patients completed the questionnaire, of whom 141(17.9%) were immigrants from low resource countries: male gender 66.7%, median age 41 (IQ range 36-46), sexual transmission reported 95.3% and injecting drug-use 14.7%, median CD4 count 455 (334-713) Moreover, 34.0% reported no sex contact and 23.9% reported prostitution in the past six months. Regular condom use was reported by only 9.0% of sexual active patients. The mean adherence reported in the last month was 95% and was higher than those reported by the Italian patients (94%): 58.4% among immigrants reported 100% of adherence. Moreover, 23.6% of immigrant patients reported spontaneous treatment interruption in the last 3 months (8.9% higher that of Italian patients), 14.6% of immigrant reported refill problems (15.2% higher than of Italian patients) and 19.1% of patients reported missed doses in the last week (0.1% higher). A overall non-adherence was considered lack of achieving adherence in any of the previous questions and was 9.0% higher among immigrants as compared with Italian patients. Using a multivariable logistic regression model, overall non-adherence was significantly associated with higher HIV-RNA level (OR: 1.7, 95% CI: 1.3-2.3) and reported injecting dug use (OR: 1.6, 95% CI: 1.1-2.3), while origin from low resource country was not associated (OR: 1.2, 95% CI: 0.8-1.8). However origin from low resource country was associated with non-adherence among non-injecting dug user males (OR: 1.7, 95% CI: 1.0-3.0). Non-adherence was generally found in immigrants reporting worse sexual behavior.
Discussion: Conclusions. Refill difficulty and consequent treatment interruption count for the major adherence problems among immigrants in Rome from low resource countries, suggesting that practical problems may limit the access to antiretroviral treatment. Otherwise adherence among immigrants is comparable to that found among Italian patients. Our results indicates that continuous counselling for sexual behavior and adherence monitoring are needed in order to target intervention to specific immigrant subgroups.
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