Date Published: October 11, 2012
Publisher: BioMed Central
Author(s): Marc I Rosen, Anne C Black, Julia H Arnsten, Jane M Simoni, Glann J Wagner, Kathleen Goggin, Robert H Remien, Carol E Golin, Yan Wang, David Bangsberg, Honghu H Liu.
Opiate substitution treatment has been associated with better adherence to lifesaving antiretroviral medications, but the impact of other substance abuse treatment on adherence is unknown.
In this study, 215 patients who had been in adherence-focused research studies provided electronically-measured adherence data and a measure of whether the patient had recently been in substance abuse treatment. Recent engagement in substance abuse treatment was independently associated with significantly higher adherence, after covarying for recent substance use and other factors potentially affecting adherence.
The findings suggest that substance abuse treatment is associated with better adherence. Potential mechanisms by which substance abuse treatment improves adherence, such as more stability or more future-orientation, require further study.
There are considerable data suggesting that current substance abuse is associated with both worse adherence to antiretroviral medications and worse attendance at HIV treatment visits
. HIV-positive patients who use drugs or alcohol may be referred to standard substance abuse treatment with the hope that medication adherence will improve with abstinence.
Substance use treatment may improve adherence by several mechanisms. Although the analyses controlled for illicit drug use, it is possible that our self-report measures of substance use understated the impact of substance abuse treatment on substance abuse and that it is in fact abstinence that facilitates adherence. In one of the few randomized controlled studies of HIV-positive drug users in which abstinence was the target outcome, there was a trend towards a significant correlation between consecutive weeks of toxicology-tested abstinence during the intervention and reductions in viral load
. There is also evidence from a naturalistic longitudinal cohort study that attendance at HIV treatment, a sine qua non for adherence, appears to improve with newly-achieved abstinence
The authors declare that they have no competing interests.
MR designed the analyses and drafted the manuscript. All the authors read and approved the final manuscript. All the authors except ACB and YW contributed patient data to the MACH 14 dataset. ACB helped design the analyses, and the aggregated dataset from which they were drawn. YW and HHL conducted the statistical analyses.