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Objective   To identify patient and physician characteristics that may act as determinants of adherence to prescription refill of triple combination antiretroviral therapy.Methods   A population-based analysis of antiretroviral therapy-naive HIV-positive men and women in British Columbia, Canada, who initiated triple combination therapy between August 1 1996 and October 31 1998. Study participants were considered adherent if they were actually dispensed antiretrovirals ≥95% over the first year of therapy. Log-binomial regression was used to identify patient and physician characteristics associated with adherence to prescription refill.Results   Of the 886 individuals eligible for analysis, 495 (56%) were ≥95% adherent to prescription refill. In multivariate analysis, adherence was positively associated with increased age [adjusted relative rate (ARR) 1.19; 95% CI: 1.07–1.32], having a diagnosis of AIDS (ARR 1.66; 95% CI: 1.29–2.15), being male (ARR 1.79; 95% CI: 1.27–2.53), and with greater experience of the treating physician (ARR 1.27; 95% CI: 1.13–1.42). History of injection drug use was negatively associated with adherence to prescription refill (ARR 0.65; 95% CI: 0.51–0.83), as was increased pill burden (per pill daily) (ARR 0.95; 95% CI: 0.92–0.99). A sub-analysis of 316 patients who provided additional data regarding psychosocial characteristics indicated that adherence was positively associated with physician experience (ARR: 1.28; 95% CI: 1.09–1.51) and being employed (ARR: 1.55; 95% CI: 1.14–2.21), and negatively associated with a history of injection drug use (ARR: 0.61; 95% CI: 0.43–0.85).Conclusion   While patient disease stage and personal characteristics may play an important role in patient adherence to prescription refill of complex therapeutic regimens, our findings indicate that HIV-experienced physicians may have greater success in maintaining patients on prescribed therapy.

Highly Active Antiretroviral Therapy: Physician Experience and Enhanced Adherence to Prescription Refill