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Adherence to Highly Active Anti-Retroviral Therapy Among HIV Seropositive Women

Women's Interagency HIV Study (WIHS)

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Adherence to Highly Active Anti-Retroviral Therapy Among HIV Seropositive Women


In 1996, potent combinations of anti-HIV drugs, including Protease Inhibitors (Pls), became the new standard of care in the treatment of HIV/AIDS.  These new drug combinations had rapid and remarkable results in terms of significantly decreased mortality and morbidity among the HIV-infected patients who took them.  The HIV virus reproduces very rapidly and is prone to developing mutations.  In a person taking a PI, any delayed or missed dose increases the likelihood that the virus will develop a mutation resistant to the PI.  If the virus in a patient's body becomes resistant, the medication will no longer be effective for him or her nor for anyone else who becomes infected with that resistant strain of the virus.  Therefore, the issue of adherence/compliance in medical regimens has taken on a new importance in the treatment of people with HIV/AIDS.  Unfortunately, PI regimens are complex and difficult to follow, requiring numerous pills to be taken in varying combinations at specific intervals, sometimes with and sometimes without food and/or fluids.  In addition, these potent medications often cause side effects including nausea, vomiting, diarrhea, abdominal pain, fever, headache, skin sores, muscle cramps, insomnia, fatigue, and weight gain or loss.

Collaboration with Cook County Hospital Women & Children's Program

Cook County Hospital (CCH) is a public facility that provides comprehensive care to women with HIV/AIDS through their innovative Women & Children's Program (WCP).  The CCH WCP recognizes that women with HIV/AIDS are often faced with many challenging life situations, including poverty, unemployment, lack of housing, alcohol/substance abuse, and mental health concerns.  Assessing and operationalizing medication adherence behaviors in the context of these life situations is essential to this study.

Study Design

Purpose:  To assess the level and types of adherence reported by HIV seropositive women who are prescribed PIs at Cook County Hospital's WCP, and to identify and understand the operation of predictors of adherence and compliance.

Protocol:  All English and Spanish speaking adult women prescribed PIs through the CCH WCP clinics between June and December 1998 (n=190), were considered for an in-person interview (lasting 11/2 - 2 hours) conducted by trained research (non-clinician) staff.  Informed consent was obtained from voluntary participants who received a stipend for their participation.  To protect participant confidentiality, identifying information was not included in the data.

Data Collection:  CCH researchers completed the recruitment and data collection process in November 8, 1999.  A total of 115 subjects were recruited for this interview study.  At present time, data are being cleaned and undergoing preparation for analysis conducted by NRTC researchers.  Preliminary results will be posted to this web page as soon as they become available.

Instruments and Measures:  The survey instrument consisted of both established and original measures.  These were chosen to assess factors that may be associated with adherence behaviors as identified by a literature review and in a provider focus group, including:

  • Sociodemographics
  • Medication behaviors
  • Facilitators and barriers to adherence (qualitative)
  • Attitudes/beliefs toward HIV medications
  • Medical encounter experience and satisfaction
  • Trust in physician
  • Self-esteem/self-efficacy
  • Social support
  • Drug/alcohol use
  • Physical and mental health symptoms
  • Functional health status
  • Neuropsychological assessments
  • Prescriptions history
  • Clinical health status indicators


To obtain presentation handout copies, or to request
more information on this project, please email Pam Steigman or
phone her at (312) 413.3162. 

To order these or related materials, visit our HIV/AIDS resource page.

  • Abstracts of Research Describing Best Practices in Ensuring Treatment Adherence.  This manual best practices in establishing adherence to medication and treatment regimens among diverse types of patients and diseases.
  • Cook, J.A. (February, 2000).  African American Women's Low Utilization of the Latest Antiretroviral Therapies for HIC/AIDS:  Is Poor Mental Health Status Part of the Problem?  Grand Rounds Presentations, UIC Department of Psychiatry, Chicago, IL.
  • Cook, J.A., Cohen, M.H., Grey, D.D., Kirstein, L., Burke, J.K., Anastos, K., Palacio, H., Richardson, J., Wilson, T., & Young, M.  (2002).  Penetration and Predictors of Use of Highly Active Antiretroviral Therapy in a Cohort of HIV-Seropositive Women, American Journal of Public Health 92(1), 82-87.

Project Staff

Judith A. Cook, Ph.D., Principal Investigator

Mardge Cohen, M.D. , Co-Principal Investigator (Cook County Hospital)

Pam Steigman, M.A., Project Coordinator

Jane Burke, M.S., Research Specialist

Patty Magaña, B.A., Research Assistant (Hektoen Institute)

Dennis Grey, B.A., Data Analyst

Project Consultants

Eileen Martin, Ph.D., ABPP/ABCN , Neuropsychology Consultant

Blake Max, Pharm.D., Pharmacy Consultant (Cook County Hospital)


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