Amsterdam 2015
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| Abstract #3445 - Late Breaker | ||||
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Session: 47.3: Late Breaker (Parallel) on Friday @ 09.00-10.30 in C001 Chaired by Ophelia Haanyama, Chen Zhang Authors: Presenting Author: Dr Michael Evangeli - Royal Holloway University of London, United Kingdom |
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| Additional Authors: | ||||
| Aim: The majority of studies of antiretroviral (ART) medication adherence in HIV-positive populations assess differences in adherence levels and predictors of adherence between participants. There is evidence, however, that many individuals living with HIV take medication inconsistently. To investigate this pattern of adherence, a within-participants design is suitable. This study aimed to investigate situational psychological factors derived from the Information Motivation Behavioral (IMB) Skill Model (Fisher, Fisher, Amico, & Harman, 2006) and behavioural factors that differentiate episodes of ART adherence and non-adherence within young people living with perinatally acquired HIV. | ||||
| Method / Issue: A within-participants cross sectional design as used with perinatally HIV-infected young people aged 13-22 years, enrolled in the UK Adolescents and Adults Living with Perinatal HIV (AALPHI) cohort study. Participants were eligible if they could identify one dose of medication taken and one dose they had missed in the previous two months. Recruitment was from three HIV clinics and one voluntary sector organisation. For each episode, behavioural factors (e.g., whom they were with, location, routine, day) and psychological factors (information about medication, adherence motivation, perceived behavioural skills to adhere to medication, and affect) were assessed in a questionnaire available in both paper and pencil and online formats. Psychological variables were measured with a 22 item-scale adapted from the Life Windows Questionnaire and with the PANAS-C scales ƕ item positive affect scale 5 item negative affect scale). Associations between behavioural and psychological factors and adherence were analysed using paired t-tests and McNemar’s chi-squared tests. Conditional logistic regression was used to investigate IMB model multivariable predictors of non-adherence. | ||||
| Results / Comments: Twenty-nine young people were recruited ྱ female, median age 17 years, range 14-22 years). Non-adherence was significantly associated with weekend days (Friday to Sunday inclusive versus Monday to Thursday inclusive, p=0.001), lack of routine versus routine (p=0.004), and being out of the home versus at home (p=0.003), but not with being alone versus being with others (p=0.34). Non-adherence was associated with lower levels of behavioural skills (non-adherent episode, mean 30.00 (sd 9.77) adherent episode, 37.92 Ɨ.29), p<0.001) and lower positive affect (non-adherent episode, mean 17.92 (sd 8.46) adherent episode, 23.85 ƙ.54), p=0.005). Adherence was not significantly associated with negative affect (p=0.08), information about ART (p=0.28), personal motivation (p=0.78) or social motivation to take ART (p=0.07). A conditional logistic regression model with behavioural skills and positive affect showed that these variables were together significantly associated with non-adherence (p=0.001) but each predictor was not significantly independently associated with non-adherence (behavioural skills AOR 0.65, 95%CI 0.41-1.03 positive affect AOR 0.83, 95%CI 0.66-1.06). | ||||
| Discussion: A number of psychological and behavioural variables differentiated adherent and non-adherent episodes in young people with perinatally acquired HIV. The role of the perceived behavioural skills (closely related to self-efficacy) and positive affect in medication adherence was supported. The importance of routine, the day of the week and location in affecting medication adherence was also suggested in the univariable analysis. The use of situationally-specific strategies to enhance adherence in young people who take their medication inconsistently is proposed. | ||||
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