| The need to understand and comply with medication instructions are of utmost importance in the treatment of persons living with HIV/AIDS. Scant attention has been given to whether patients understand their condition, their prescribed treatment, and if they know how to follow the complicated antiretroviral (ARV) medication regime usually prescribed to combat HIV.; The purpose of this study was to investigate the factor of literacy, both alone and in combination with other factors, and to determine the association of literacy skill with ARV medication adherence in a group of persons living with HIV.; To answer the research question, a subset of data derived from the "Outpatient Nurse Managed HIV Adherence Trial" was analyzed with analysis of additional data collected during the "Literacy Supplement." The dependent variable, ARV medication adherence, was measured by patient self-report, pharmacy prescription refills, and pill count. Independent variables were health literacy skill, perceived social support, and depressive symptomatology. Covariates included age, years of education, and duration of HIV illness. Data were collected from a total of 131 HIV-positive patients who were being treated with ARV medication therapy. Data were collected over six months for each subject.; The results revealed that twelfth grade was the average completed grade in school but actual median literacy skills in the sample were between the seventh and eighth grade. On average, patients refilled 70% of their ARV prescriptions with only 26% achieving optimal adherence (90% or greater). After adjusting for perceived social support, depressive symptomatology, education about their illness, and years living with HIV, subjects with a moderately low reading skill level were more likely to achieve ARV adherence of 90% or greater. Multivariate analyses revealed that a higher level of literacy, self-identifying as African-American or Hispanic, and not being employed for pay were associated with lower ARV adherence.; These findings point to the need for greater research attention on health literacy as a determinant of medication adherence. Further study is needed to clarify the complex relationships between adherence, health literacy, and patient characteristics. |
