Patterns of drug utilization amongst outpatients with HIV infection in Ontario, Canada.
Published: 2004
Language: eng
Number of pages: 339
Description: This study sought to quantify and describe the utilization of prescription, over-the-counter (OTC), complementary and alternative medicine (CAM) and social/recreational drugs in a cohort of HIV-infected outpatients in Ontario, Canada. In total, 104 adults (49 women/55 men) were recruited through nine hospital-based HIV clinics from participants in the HIV Ontario Observational Database cohort. Overall drug utilization, demographics and disease characteristics were collected using in-person interviews and retrospective medical chart reviews. Results were compared between collection methods and between men and women. Longitudinal patterns of antiretroviral use were assessed and compliance to treatment guidelines was evaluated. Impact of operational CAM definitions was also considered. Drug utilization was extremely high. All patients self-reported the use of at least one drug, with the majority reporting major polypharmacy (&ge;5 drugs), averaging 15.7 +/- 7.7 drugs overall. By medical chart review, 96% of patients reported using drugs, most using >5 drugs. The mean was significantly lower (8.4 +/- 5.0 drugs per person, P &lt; 0.05). Differences by data source held true for all drug categories, as well as for individual drug classes. Agreement was highest for antiretrovirals, where triple therapy was reported for the majority of patient and medical chart reports. By either data source, there were minimal differences in reported drug use by gender, although differences were seen in use of CAM and certain individual drug classes. Longitudinally, there was an ecological correlation in choice of antiretroviral regimen by gender, with a slight delay evident for women in initiating mono- then dual- and triple antiretroviral therapy, a difference that became significant in early 1997. Despite this correlation, there were no significant delays by gender in time from HIV diagnosis to antiretroviral or HAART initiation. Finally, CAM definition plays a significant role in reported prevalence and predictors of drug use, emphasizing the importance of standardized definitions in research. Overall the thesis findings have emphasized not only the considerable burden associated with drug use in HIV but also the importance of patient-physician communication regarding all aspects of drug utilization. Further, although substantial gender differences in current drug use were not found, the need for sensitivity to such potential differential treatment is highlighted.
Notes: Advisers:  R. Bendayan; T. Einarson.

Thesis (Ph.D.)--University of Toronto, 2004.

Electronic version licensed for access by U. of T. users.

Source: Dissertation Abstracts International, Volume: 65-10, Section: B, page: 5101.