Adherence to HAART in the Homeless Population in San Francisco: 31% in Study Discontinued Therapy

Researchers ant UCSF and Stanford University examined adherence to HAART among the homeless, a population thought to be at high risk for poor adherence to therapy and for development of drug-resistant strains of HIV.

They performed a 12-month prospective study of 148 persons receiving HAART who were identified in a stratified screening of the homeless and marginally housed.

They sampled in lunch lines, shelters, and hotels in 3 neighborhoods of San Francisco, California. They 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

The authors conclude, “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.”

Departments of Epidemiology and Biostatistics and Medicine, University of California, San Francisco, and Department of Medicine, Stanford University Medical Center, Stanford, California.

10/04/04

Reference
A R Moss and others. Adherence to Highly Active Antiretroviral Therapy in the Homeless Population in San Francisco: A Prospective Study. Clinical Infectious Diseases 39(8): 1190-1198. October 15, 2004.