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One of the most challenging aspects of treating patients who have AIDS is finding ways to increase adherence to the often complicated medication regimen. Failure to adhere strictly not only harms the patient but permits the development of viral resistance to powerful antiretroviral medications. Such resistance, in turn, may lead to transmission of resistant strains of HIV.


A recent study of incarcerated HIV-positive women evaluated patient attitudes regarding AIDS treatment and how these attitudes influence medication adherence. The study permitted an assessment of medication acceptance and adherence that was independent of both financial constraints and the usual issues of access to care.


The sole correctional facility for women in the state of Connecticut houses an average of 660 women daily, of whom 15% at any given time are HIV positive. A total of 120 patients with CD4+ counts less than 200 cells/[micro]L were eligible, and 102 agreed to participate. They were questioned by research staff regarding their attitudes and their antiretroviral medication acceptance and adherence.


*Attitudes and beliefs. A majority of patients were found to trust HIV medications overall: 71% felt that HIV medications increase survival, and 82% thought that taking HIV medications had not harmed a friend. They indicated overall satisfaction with their HIV physician: 71% believed that their HIV physicians always listened to them, although only 59% believed their physicians always understood. While only 29% rated overall health care offered to inmates as excellent, 55% rated their HIV-related care as excellent.


*Antiretroviral acceptance and adherence. About two-thirds of the women accepted the antiretroviral treatment in prison upon first offer; three-quarters interviewed were currently taking medication. Adherence, defined as taking all doses of prescribed medication six or more days of the week, was reported by 62% of the women, a comparable level to that found in hospital-affiliated outpatient services for HIV-positive patients. Eleven percent took some medication on six or more days per week but had missed at least one dose daily, while 28% reported taking none of their medication on two or more days per week.


*Correlation between attitudes and beliefs and acceptance and adherence. Trust in antiretroviral medication was strongly correlated with initial and current acceptance of HIV medication, as was satisfaction with the institution's health care; but neither correlated with medication adherence. Satisfaction with the HIV physician relationship and emotional support were most strongly correlated with medication adherence.


These findings demonstrate the necessity in all HIV treatment settings of assessing the patient's attitudes and beliefs prior to offering prescriptions.


Source: Mostashari, F., et al. J.Acquir.Immune Defic.Syndr. 18:341-348, Aug. 1, 1998