Abstract #247  -  Information, motivation, and behavioral skills barriers associated with intentional vs. unintentional ARV non-adherence behavior among HIV-positive patients in clinical care
Authors:   Presenting Author:   Ms. Wynne Norton - University of Connecticut
Additional Authors:  PhD K. Rivet Amico, PhD William A.  Fisher, PhD Deborah H. Cornman, PhD Paul A. Shuper, BA Cynthia Trayling, MSR Caroline Redding, MA Rebecca A. Ferrer, PhD Jeffrey D. Fisher,
Aim: Relatively high levels of adherence to antiretroviral (ARV) medications are necessary to maintain optimal health status among HIV-positive patients. Although research has successfully identified various ARV adherence-related barriers, relatively little work has focused on distinguishing between specific barriers associated with intentional vs. unintentional non-adherent behavior. The objective of the present study was to examine baseline differences in adherence-related barriers between non-adherent HIV-positive patients in clinical care who reported intentionally stopping some or all of one¡¯s medications (taking a break) compared to those who did not.
Method / Issue: This sub-study was part of a larger, randomized controlled intervention trial to evaluate an interactive, individually-tailored, computerized ARV adherence enhancement program delivered to HIV-positive patients at five clinical care sites in Connecticut. The current findings utilize the Information-Motivation-Behavioral Skills Model of Adherence (IMB) as a framework for identifying and understanding adherence-related barriers as they relate to intentional versus unintentional non-adherence behavior among a sample of HIV-positive patients. Demographic information and adherence-specific information, motivation, and behavioral skills items were collected as part of the broader study assessment at baseline. The full sample (N = 594) completed a modified VAS measure of adherence over the last 3-4 weeks. Perfect (100%) versus imperfect (<100%) adherence was used to identify a subsample of non-adherent patients. Non-adherent participants were further classified on the basis of their responses to an item asking if they were currently taking a break from their ARV medications without first talking with their healthcare provider. Patients responding yes to this single-item question were classified as intentional non-adherers while those responding no were considered unintentional non-adherers. IMB-model based barriers were assessed by the LW-IMB-AAQ and measured on a five-point Likert-type scale (1 = Strongly Disagree, 5 = Strongly Agree). A series of one-way ANOVAs were conducted to compare responses of those reporting intentional versus unintentional non-adherence to each of the adherence-related information, motivation, and behavioral skills items.
Results / Comments: At baseline, 327 HIV-positive patients reported less than 100% adherence on the VAS. Of these 327 participants, most were male (57.2%), an average of 46 years old (SD = 7.9), heterosexual (76.5%), African-American (49.5%), and reported an annual income less than 10K per year (69.4%). Of the 327 HIV patients who reported less than perfect adherence at baseline, 29 (~9%) were classified as intentional non-adherers while the remainder (n = 298, 91%) were classified as unintentional non-adherers. Participants reporting intentional versus unintentional non-adherence differed significantly (p¡Ü.05) with respect to many of the adherence-related information, motivation, and behavioral skills barriers assessed. A large number of the discrepancies between these two types of non-adherers appeared to be in terms of behavioral skills, with intentional non-adherent patients reporting greater difficulty in this area than unintentional non-adherers.
Discussion: The current results suggest that HIV-positive patients who report intentional non-adherence may have particularly greater difficulty with adherence-related behavioral skills compared to those reporting unintentional non-adherence. Conceptualizing non-adherence as intentional vs. unintentional and identifying specific barriers associated with each has important implications for better understanding¡ªand ultimately helping¡ªpatients adhere to their medications.
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