Adherence to Highly Active Antiretroviral Therapy in the Homeless Population in San Francisco: A Prospective Study

• DOI: 10.1086/424008
• Publication Date: 2004-10-04T10:49:54Z
• Authors: A. R. Moss; J. A. Hahn; S. Perry; E. D. Charlebois; D. Guzman; R. A. Clark; D. R. Bangsberg
• Keywords: Adult; Male; Anti-HIV Agents; 1. No poverty; HIV Infections; Middle Aged; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Antiretroviral Therapy, Highly Active; Ill-Housed Persons; Multivariate Analysis; Humans; Patient Compliance; Female; San Francisco; Longitudinal Studies; Prospective Studies

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).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.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.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.