Adherence to highly active antiretroviral therapy in the homeless population in San Francisco: A prospective study

Andrew R. Moss, Judith A. Hahn, Sharon Perry, Edwin D. Charlebois, David Guzman, Richard A. Clark, David Bangsberg

Research output: Contribution to journalArticle

113 Citations (Scopus)

Abstract

Background. We examined adherence to highly active antiretroviral therapy (HAART) in the homeless population, a population thought to be at high risk for poor adherence to therapy and for development of drug-resistant strains of human immunodeficiency virus (HIV). Methods. We performed a 12-month prospective study of 148 persons receiving HAART who were identified in a stratified screening of the homeless and marginally housed. We sampled in lunch lines, shelters, and hotels in 3 neighborhoods of San Francisco, California. We used pill counts at unannounced home visits as the primary measure of adherence. Results. Of 148 individuals sampled, 46 (31%) discontinued HAART during the study. Average adherence in the group of those who discontinued HAART was 51%, and 9% of these subjects had undetectable virus loads (i.e., <400 copies/mL) at the last follow-up visit. Predictors of discontinuation of therapy were depressive symptoms, injection drug use, African American ethnicity, and early poor adherence. Of 148 subjects, 102 (69%) continued to receive HAART throughout the study period. Average adherence in the group of those who continued to receive HAART was 74%, and 55% of these subjects had undetectable virus loads at the last follow-up visit. Predictors of lower average adherence in this group were African American ethnicity and use of crack cocaine; men who had sex with men had higher adherence. Conclusions. One-third of homeless and marginally housed persons receiving HAART discontinued therapy during the follow-up period and would benefit from adherence interventions directed at sustaining therapy; two-thirds continued to receive therapy at adherence levels comparable to those found with other clinical populations.

Original languageEnglish (US)
Pages (from-to)1190-1198
Number of pages9
JournalClinical Infectious Diseases
Volume39
Issue number8
DOIs
StatePublished - Oct 15 2004
Externally publishedYes

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San Francisco
Highly Active Antiretroviral Therapy
Prospective Studies
Population
African Americans
Crack Cocaine
Viruses
Lunch
House Calls
Therapeutics
HIV
Depression
Drug Therapy
Injections
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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Adherence to highly active antiretroviral therapy in the homeless population in San Francisco : A prospective study. / Moss, Andrew R.; Hahn, Judith A.; Perry, Sharon; Charlebois, Edwin D.; Guzman, David; Clark, Richard A.; Bangsberg, David.

In: Clinical Infectious Diseases, Vol. 39, No. 8, 15.10.2004, p. 1190-1198.

Research output: Contribution to journalArticle

Moss, Andrew R. ; Hahn, Judith A. ; Perry, Sharon ; Charlebois, Edwin D. ; Guzman, David ; Clark, Richard A. ; Bangsberg, David. / Adherence to highly active antiretroviral therapy in the homeless population in San Francisco : A prospective study. In: Clinical Infectious Diseases. 2004 ; Vol. 39, No. 8. pp. 1190-1198.
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abstract = "Background. We examined adherence to highly active antiretroviral therapy (HAART) in the homeless population, a population thought to be at high risk for poor adherence to therapy and for development of drug-resistant strains of human immunodeficiency virus (HIV). Methods. We performed a 12-month prospective study of 148 persons receiving HAART who were identified in a stratified screening of the homeless and marginally housed. We sampled in lunch lines, shelters, and hotels in 3 neighborhoods of San Francisco, California. We used pill counts at unannounced home visits as the primary measure of adherence. Results. Of 148 individuals sampled, 46 (31{\%}) discontinued HAART during the study. Average adherence in the group of those who discontinued HAART was 51{\%}, and 9{\%} of these subjects had undetectable virus loads (i.e., <400 copies/mL) at the last follow-up visit. Predictors of discontinuation of therapy were depressive symptoms, injection drug use, African American ethnicity, and early poor adherence. Of 148 subjects, 102 (69{\%}) continued to receive HAART throughout the study period. Average adherence in the group of those who continued to receive HAART was 74{\%}, and 55{\%} of these subjects had undetectable virus loads at the last follow-up visit. Predictors of lower average adherence in this group were African American ethnicity and use of crack cocaine; men who had sex with men had higher adherence. Conclusions. One-third of homeless and marginally housed persons receiving HAART discontinued therapy during the follow-up period and would benefit from adherence interventions directed at sustaining therapy; two-thirds continued to receive therapy at adherence levels comparable to those found with other clinical populations.",
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