Predictors of self-reported adherence in persons living with HIV disease

This study examined the relationships between the five dimensions of the Wi lson and Cleary model of health-related quality of life and three self-repo rted adherence measures in persons living with HIV using a descriptive surv ey design. Data collection occurred in seven cities across the United State s, including university-based AIDS clinics, private practices, public and f or-profit hospitals, residential and day-care facilities, community-based o rganizations, and home care. The three dependent adherence measures studied were "medication nonadherence," "follows provider advice," and "missed app ointments." The sample included 420 persons living with HIV disease with a mean age of 39 years of which 20% were women and 51% were white; subjects h ad a mean CD4 count of 321 mm(3). HIV-positive clients with higher symptom scores, particularly depression, were more likely to be nonadherent to medi cation, not to follow provider advice, and to miss appointments. Participan ts who reported having a meaningful life, feeling comfortable and well care d for, using their time wisely, and taking time for important things were b oth more adherent to their medications and more likely to follow provider's advice. No evidence was found demonstrating any relationship between adher ence and age, gender, ethnicity, or history of injection drug use. These fi ndings support the need to treat symptoms, particularly depression, and to understand clients' perceptions of their environment as strategies to enhan ce adherence. A limitation of this study was that adherence was measured on ly by self-report; however, the study did expand the concept of adherence i n HIV care beyond medication adherence to include following instructions an d keeping appointments.