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Research Summary

Medication-specific Support May Reduce the Impact of Alcohol and Other Drug Use on Antiretroviral Adherence

The effectiveness of antiretroviral therapy (ART) among people with HIV/AIDS depends on high adherence over time. Alcohol and other drug (AOD) problems are associated with lower ART adherence. Researchers examined data collected during a trial of interventions to improve ART adherence (text message reminders, peer discussions, or both) (N=224). The question for this secondary data analysis (adjusted for intervention group assignment) was whether self-report of having received social* or medication-specific support** buffered the effect of AOD use on adherence. General social support was measured with the 19-item Medical Outcomes Study-Social Support survey, while medication-specific support was measured with an 8-item survey created by the investigators. At baseline, 27% of the sample reported past-year unhealthy alcohol use (AUDIT† score >7) and 55% reported past-year heroin, cocaine, or methamphetamine use.

  • General social support did not have a significant effect on the association between AOD use and ART adherence.
  • Medication-specific support had a moderating effect at 3 months but not at 6 or 9 months, during which time support decreased. For example, for those reporting high medication-specific support, 100% medication adherence was reported for 75–77% of participants with and without unhealthy alcohol use. But for those with low medication support, 100% adherence was reported by 67% of those without and 37% of those with unhealthy alcohol use. Findings were similar for those with weekly drug use versus less frequent use.
*E.g., having another person to confide in or enjoy activities with. **E.g., having another person remind the patient to take his or her medication or assist with taking medication. †AUDIT=Alcohol Use Disorders Identification Test.

Comments:

This study suggests medication-specific support can decrease the detrimental effect that AOD use has on ART adherence among patients with HIV/AIDS. Patients may benefit from finding ways to sustain such support over time. In the meantime, it makes sense for practitioners to ask patients to identify people who can provide this type of support and to get them involved in helping patients take their medications. Darius A. Rastegar, MD

Reference:

Lehavot K, Huh D, Walters KL, et al. Buffering effects of general and medication-specific social support on the association between substance use and HIV medication adherence. AIDS Patient Care STDs. 2011;25(3):181–189.

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