Background: The association of health care factors with ARV adherence has been poorly elucidated. Methods: Of 9557 non-pregnant HIV+ drug users enrolled >10 months in New York State Medicaid in 1997, we studied those with filled ARV prescriptions for >6 months and >2 months on 2+ ARVs of that year. Adherence was defined as >90% of days covered by filled prescribed drugs from first date of 2+ ARVs through last ARV(s) prescribed in 1997, with inpatient days adherent. From claims files, we identified clinical conditions (i.e. HIV stage, substance abuse type, general medical) and health care factors in 1997 including: regular medical care (>35% of visits to one provider); regular substance abuse treatment (6+ months with one provider); any HIV specialty care (e.g., infectious diseases or enhanced HIV payment rates); and any psychiatric care (and visit #). Logistic regression models were estimated for >90% adherence to 2+ ARVs in 1997 adjusting for demographics, clinical conditions and health care factors. Results: Of 4922 drug users, 34.6% were >90% adherent to combination ARVs by the pharmacy measure. Of health care factors, only psychiatric care (received by 30%) was associated with improved adherence (adjusted odds ratio (AOR) 1.23 [CI 1.04, 1.46]). In a second model, the AORs rose with more psychiatric visits (1-2 visits AOR 1.01 [CI .80, 1.26]; 3-10 visits AOR 1.28 [1.01, 1.64]; 11+ visits AOR 1.55 [CI 1.22, 1.98]) vs none. Conclusion: At least three visits for psychiatric care for HIV+ drug users may promote adherence to combination ARV treatment.
Learning Objectives: 1. To understand the association of specific types of ambulatory care with adherence to antiretroviral therapy in drug users 2. To describe a pharmacy claims-based approach to assessing adherence in population-based samples
Keywords: Adherence, Substance Abuse
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.