Sponsor
Bill and Melinda Gates Foundation (OPP1056051). The study funder had no role in study design, data gathering, analysis and interpretation, or writing of the report. The corresponding author had full access to all study data and had final responsibility for the decision to submit for publication.
Published In
Journal of the International AIDS Society
Document Type
Article
Publication Date
2019
Subjects
HIV infections -- South Africa -- Treatment, HIV -- Case studies
Abstract
Introduction
The success of universal antiretroviral therapy (ART) access and aspirations for an AIDS‐free generation depend on high adherence in individuals initiating ART during early‐stage HIV infection; however, adherence may be difficult in the absence of illness and associated support.
Methods
From March 2015 to October 2017, we prospectively observed three groups initiating ART in routine care in Uganda and South Africa: men and non‐pregnant women with early‐stage HIV infection (CD4 > 350 cells/μL), pregnant women with early‐stage HIV infection and men and non‐pregnant women with late‐stage HIV infection (CD4 < 200 cells/μL). Socio‐behavioural questionnaires were administered and viral loads were performed at 0, 6 and 12 months. Adherence was monitored electronically.
Results
Adherence data were available for 869 participants: 322 (37%) early/non‐pregnant, 199 (23%) early/pregnant and 348 (40%) late/non‐pregnant participants. In Uganda, median adherence was 89% (interquartile range 74 to 96) and viral suppression was 90% at 12 months; neither differed among groups (p > 0.72). In South Africa, median adherence was higher in early/non‐pregnant versus early/pregnant or late/non‐pregnant participants (76%, 37%, 52%; p < 0.001), with similar trends in viral suppression (86%, 51%, 79%; p < 0.001). Among early/non‐pregnant individuals in Uganda, adherence was higher with increasing age and lower with structural barriers; whereas in South Africa, adherence was higher with regular income, higher perceived stigma and use of other medications, but lower with maladaptive coping and cigarette smoking.
Discussion
ART adherence among non‐pregnant individuals with early‐stage infection is as high or higher than with late‐stage initiation, supporting universal access to ART. Challenges remain for some pregnant women and individuals with late‐stage infection in South Africa and highlight the need for differentiated care delivery.
Locate the Document
DOI
10.1002/jia2.25232
Persistent Identifier
https://archives.pdx.edu/ds/psu/28523
Publisher
Wiley
Citation Details
Haberer, J. E., Bwana, B. M., Orrell, C., Asiimwe, S., Amanyire, G., Musinguzi, N., ... & Bell, K. (2019). ART adherence and viral suppression are high among most non‐pregnant individuals with early‐stage, asymptomatic HIV infection: an observational study from Uganda and South Africa. Journal of the International AIDS Society, 22(2), e25232.
Description
© 2019 The Authors. Journal of the International AIDS Society published by John Wiley & Sons Ltd on behalf of the International AIDS Society.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.