AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #63 - Medication adherence and diversion among HIV-positive substance abusers in South Florida
Authors: Presenting Author: Dr. Hilary Surratt - Nova Southeastern University
Additional Authors: Dr. Steven Kurtz, Ms. Leah Varga,
Aim: Medication adherence is a critical element in the management of many chronic illnesses, including HIV. Non-adherence can lead to viral replication and mutation, increasing the chances of treatment failure and drug resistance. This paper examines the predictors of antiretroviral (ARV) medication adherence among drug-involved HIV-positive individuals in Miami, and investigates a related, yet previously unstudied topic -- the diversion of ARV medications to the street market.
Method / Issue: Using targeted sampling strategies, this study is enrolling indigent, HIV+ cocaine and heroin users in South Florida. To date, we have conducted structured face to face interviews with 291 individuals using standardized data collection instruments. Bivariate logistic regression models were developed to examine factors associated with ARV medication adherence and diversion.
Results / Comments: The sample has a median age of 46 and 49.1% meet criteria for past year substance dependence. 77% of study participants reported monthly income of less than $1,000; 35.7% were homeless in the prior 3 months. Self-reported ARV medication adherence in the past week was less than 80% among 22.7% of the sample; 60.8% achieved 95% or greater adherence. The odds of 80% or better adherence were significantly lower among participants reporting severe depression, anxiety, or traumatic stress, as well as those reporting current homelessness, high HIV-related stigma, and high neighborhood disorder. Severe depression and homelessness were also associated with the diversion of ARV medications in the 90 days prior to interview. The odds of diversion were lower among participants with higher HIV knowledge, higher health literacy, and more positive attitudes about ARV medication.
Discussion: The health implications of ARV non-adherence and diversion among HIV+ chronic drug users are substantial. Many individuals are not consistently adhering to their medication regimens, and therefore fail to achieve the full benefits of ARV treatment. ARV medication diversion is visible in South Florida drug markets, and is likely occurring in other major urban centers as well. Study participants routinely reported being targeted by pill brokers or “collectors” offering small financial incentives to purchase their medications. Interventions to enhance medication adherence and reduce diversion should be tailored for the most vulnerable, homeless HIV+ individuals. Economic vulnerability, stigma, mistrust of ARVs, and low levels of knowledge about ARV treatment regimens must be addressed in intervention initiatives with this highly marginalized population.
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