Regimen Complexity in Aging HIV-Infected Veterans: Data from HAVACS Pubblico

Abstract

Advances in antiretroviral (ARV) medication regimens have greatly contributed to the increased survival and subsequent aging of the population of persons living with HIV/AIDS (PLWHA). While the total daily pill burden for ARV and non-ARV medications has been examined by age in HIV-infected patients, regimen complexity is another aspect of polypharmacy that has been associated with adherence and clinical outcomes. The HIV Atlanta VA Cohort Study (HAVACS) includes all HIV-infected veterans seen at the Atlanta VA Medical Center since 1982. The Medication Regimen Complexity Index (MRCI), developed by the University of Colorado Denver, was used to determine the complexity of a patient’s medication process for a randomly selected subset of 146 patients prescribed medication and seen between January 1, 2004 - October 31, 2014. The MRCI score takes into account the route, dose, and frequency. The higher the MRCI scores, the greater the regimen complexity. Chi-square, Fischer’s exact tests, and one-way analysis of variance were used to compare the MRCI score across age groups. Patients were separated by age into three categories; Age Group 1: 23-44 years (mean 37) (n=47), Age Group 2: 45-55 years (mean 47) (n=50), and Age Group 3: 56-92 years (mean 63.6) (n=49). There was a statistically significant difference in MRCI mean score among the groups (p<0.0001). Mean MRCI scores by Age Group are: Group 1 mean score of 10.3, Group 2 mean score of 14.0 and Group 3 mean score of 20.9. Figure 1 shows the distribution of MRCI scores among the three age categories. Further analysis showed that there was a statistically significant difference in MRCI score means between Age Groups 1 and 3 (p < 0.0001) and Age Groups 2 and 3 (p= 0.004). The magnitude of the MRCI score varied significantly across the three age groups. Greater regimen complexity was seen with the oldest age group. Individually, age and regimen complexity have been associated with nonadherence. As PLWHA continue to age, measures of polypharmacy will be an essential component of clinical success.

Table of Contents

Chapter I: Literature Review……………………………………………………………..1

Chapter II: Manuscript…………………………………………………………………...18

Abstract…………………………………………………………………………..18

Introduction………………………………………………………………………19

Methods…………………………………………………………………………..21

Results……………………………………………………………………………22

Discussion……………………………………………………………………......25

References………………………………………………………………………………..29

Tables…………………………………………………………………………………….34

Figures……………………………………………………………………………………36

Chapter III: Summary, Public Health Implications, Future Directions…………………38

Appendix A………………………………………………………………………………42

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Health Care Management Health Sciences, Epidemiology
Parola chiave	HIV HAVACS MRCI
Committee Chair / Thesis Advisor	Guest, Jodie, Emory University
Partnering Agencies	Hospital or other health care provider

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