Marseille 2007
| Abstract #292 - Psychosocial aspects associated with HIV treatment adherence: Results of Promosud cohort | ||||
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Session: 26.78: Posters B (Poster) on Tuesday in Chaired by Authors: Presenting Author: Prof delmas philippe - hopital Vaugirard, France |
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| Additional Authors: Dr delpierre cyrille, Prof cot jos, | ||||
| Aim: To identify psychosocial characteristics associated with non adherence in a french HIV-infected population | ||||
| Method / Issue: Promosud study was a cohort conducted in six HIV unit of Midi Pyrnes region, following 133 HIV-infected patients during one year. Patients, included during the second semester of 2004, were all adherent at inclusion. Patients were classified as adherent if they declared having totally followed their treatment prescription in the last two days before each evaluation and if in the same time their viral load was under 50 copies/ml. Patients had to complete a questionnary at baseline, six (M6) and 12 months later (M12). The explored dimensions and the corresponding scales were: stress (Stress Appraisal Measure, Peacock &Wong, 1990), social support (Social Provision Scale, Cutrona & Russel, 1987), side effects (Scale, Justice, et al., 2001), coping strategies (Ways of Coping Questionnaire, Lazarus &Folkman, 1984), quality of life (Medical Outcomes Study, Wu, et al., 1991 identified Mental Health Summary score (MHS) and Physical Health Summary score (PHS)) and perceived health status (Echelle Visuelle Analogique, Davies, et al., 1975). Sociodemographics variables were also collected. Logistic regression models were performed including first variables at baseline and then variables at M12. For each model, psychosocial variables were included first, then side effects, and finally PHS, MHS and perceived health status. | ||||
| Results / Comments: Among the 133 patients included in this cohort, 115 (86.5%) were interviewed at M12. Forty-one patients (35.7%) are become at least one time non-adherent during the follow up. Age, gender, socioeconomic status (education, occupational class) and marital status were not associated with adherence. Considering only variables at baseline, non-adherent patients had a lower MHS (47.2 vs 51.1, p=0.04), PHS (48.7 vs 52.5, p=0.04) and perceived health status (7.6 vs 8.4, p=0.02) in bivariate analysis. In mutivariate analysis, only a high perceived health status at baseline was predictive of adherence (OR=1.32, 95% CI: 1.04-1.68). After including variables at M12, no baseline characteristics were associated with adherence. Psychosocial variables associated with non-adherence were a higher score of stress (2.6 vs 2.2, p=0.03), mediated by a higher score of menace (2.6 vs 2.2, p=0.04) and a lower score of control (3.5 vs 3.7, p=0.04), and a lower score of reevaluation at M12 (2.2 vs 2.5, p=0.02). In mutivariate analysis, a higher score of menace and a lower score of reevaluation were risk factors of non-adherence. Reevaluation was the only psychosocial variable still linked with non-adherence after adjustment on side effects score, which was higher in non-adherent patients. After including PHS, MHS and perceived health status at M12, the only factor associated with adherence was PHS (OR=1.08, 95% CI: 1.03-1.15). | ||||
| Discussion: Non-adherent patients were characterised by a high level of stress, mediated by the feeling of menace, and by a difficulty for evaluationg positively their situation. Side effects were more frequently reported by non adherent patients and had a major impact on physical health which constituted the main factor associated with adherence. It is noteworthy that low perceived health status at inclusion was associated with future non-adherence. This indicator could be useful to prevent ruptures in adherence and should be evaluated more frequently. | ||||
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