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Antiretroviral Adherence Among Rural Compared to Urban Veterans with HIV Infection in the United States

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Abstract

Rural-dwelling persons with HIV infection face barriers to maintaining high levels of antiretroviral adherence. We compared adherence among 1,782 rural and 18,519 urban veterans initiating antiretroviral therapy in the Veterans Affairs (VA) healthcare system in the United States between 1998 and 2007. Residence was determined using rural urban commuting area codes and adherence using pharmacy-based refill measures. The median proportion of days covered (PDC) by combination antiretroviral therapy in the first year of treatment ranged from 0.72 among urban residents to 0.79 among rural-small town/remote residents (p < 0.0001). In multivariable logistic regression, predictors of high adherence (PDC greater than 0.90) were residence in a rural-small town/remote setting (odds ratio 1.24, 95 % CI 1.09–1.56, relative to urban), increasing age, white race, absence of an alcohol or substance use disorder, and absence of hepatitis C infection. Results may differ outside VA healthcare, where there may be fewer resources to support adherence among rural-dwelling persons with HIV.

Resumen

Las personas con la infección del HIV que habitan en áreas rurales se enfrentan para mantener los altos niveles de adherencia antirretroviral. Comparamos la adherencia entre 1,782 veteranos rurales y 18,519 veteranos urbanos que iniciaron la Terapia Antirretroviral con el Sistema de Salud para Veteranos “Veterans Affairs” (VA) en Los Estados Unidos entre los años 1998 y 2007. El tipo de residencia fue determinado de acuerdo a los códigos del Rural Urban Commuting Area y la adherencia usando las medidas en las que se basan las farmacias para medir los resurtidos de medicamentos. El porcentaje medio de los días cubiertos (PDC) y la combinación con la Terapia de Antirretroviral en el primer año de tratamiento estuvo en el rango de 0.72 entre los residentes urbanos y 0.79 entre los residentes rurales y residentes de pueblos remotos y pequeños (p < 0,0001). En la regresión logística multivariable, predictores de alta adherencia (PDC mayor de 0.90) fueron los residentes de áreas rurales remotas y pueblos pequeños (Posible Radio 95 % CI 1.09–1.56, con relación a los del área urbana), el aumento de la edad, la raza blanca, ausencia de trastornos de alcohol o el uso de sustancias y la ausencia de la infección de la Hepatitis C. Los resultados pueden diferir fuera de el sistema de salud (VA), donde pueden existir menos recursos para apoyar la adherencia entre las personas con VIH que viven en áreas rurales.

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Acknowledgments

The work reported here was supported by the Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center-Central Region. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States government.

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Authors and Affiliations

  1. VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region, Iowa City VA Medical Center, Iowa City, IA, USA

    Michael E. Ohl & Eli Perencevich

  2. Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Medical Center, Mailstop 152, Iowa City, IA, 52246, USA

    Michael E. Ohl & Eli Perencevich

  3. Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA

    Michael E. Ohl & Eli Perencevich

  4. Center for Health Quality Outcomes and Economic Research, ENRM VA Medical Center, Bedford, MA, USA

    D. Keith McInnes

  5. Department of Health Care Policy, Boston University School of Public Health, Boston, MA, USA

    D. Keith McInnes

  6. Yale University Schools of Medicine and Public Health, VA Connecticut Healthcare System, New Haven, CT, USA

    Nancy Kim, Kathleen Akgun, David A. Fiellin, Melissa Skanderson, Karen Wang & Amy Justice

  7. Atlanta VAMC and Emory University School of Medicine, Atlanta, GA, USA

    David Rimland

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  1. Michael E. Ohl
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  2. Eli Perencevich
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  4. Nancy Kim
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  7. David A. Fiellin
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  8. Melissa Skanderson
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  9. Karen Wang
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  10. Amy Justice
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Correspondence to Michael E. Ohl.

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Ohl, M.E., Perencevich, E., McInnes, D.K. et al. Antiretroviral Adherence Among Rural Compared to Urban Veterans with HIV Infection in the United States. AIDS Behav 17, 174–180 (2013). https://doi.org/10.1007/s10461-012-0325-8

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  • DOI: https://doi.org/10.1007/s10461-012-0325-8

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