Sponsor
This research has been supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the Centers for Disease Control and Prevention (CDC) and the Health Resources & Services Administration (HRSA) under the terms of the contract no. 2006-N-08428 with FHI 360.
Published In
AIDS
Document Type
Post-Print
Publication Date
1-2015
Subjects
AIDS (Disease) -- Sub-Saharan Africa -- Treatment, Patient compliance -- Sub-Saharan Africa -- Qualitative studies, Antiretroviral therapy
Physical Description
20 pages
Abstract
Objectives—To characterize antiretroviral therapy (ART) adherence across different programmes and examine the relationship between individual and programme characteristics and incomplete adherence among ART clients in sub-Saharan Africa.
Design—A cross-sectional study.
Methods—Systematically selected ART clients (≥18 years; on ART ≥6 months) attending 18 facilities in three countries (250 clients/facility) were interviewed. Client self-reports (3-day, 30-day, Case Index ≥48 consecutive hours of missed ART), healthcare provider estimates and the pharmacy medication possession ratio (MPR) were used to estimate ART adherence. Participants from two facilities per country underwent HIV RNA testing. Optimal adherence measures were selected on the basis of degree of association with concurrent HIV RNA dichotomized at less than or greater/equal to 1000 copies/ml. Multivariate regression analysis, adjusted for site-level clustering, assessed associations between incomplete adherence and individual and programme factors.
Results—A total of 4489 participants were included, of whom 1498 underwent HIV RNA testing. Nonadherence ranged from 3.2% missing at least 48 consecutive hours to 40.1% having an MPR of less than 90%. The percentage with HIV RNA at least 1000 copies/ml ranged from 7.2 to 17.2% across study sites (mean = 9.9%). Having at least 48 consecutive hours of missed ART was the adherence measure most strongly related to virologic failure. Factors significantly related to incomplete adherence included visiting a traditional healer, screening positive for alcohol abuse, experiencing more HIV symptoms, having an ART regimen without nevirapine and greater levels of internalized stigma.
Conclusion—Results support more in-depth investigations of the role of traditional healers, and the development of interventions to address alcohol abuse and internalized stigma among treatment-experienced adult ART patients.
DOI
10.1097/QAD.0000000000000543
Persistent Identifier
http://archives.pdx.edu/ds/psu/18618
Publisher
Lippincott, Williams & Wilkins
Citation Details
80. Denison JA, Koole O, Tsui S, Menten J, Torpey K, van Praag E, Mukadi YD, Colebunders R, Auld AF, Agolory S, Kaplan JE, Mulenga M, Kwesigabo GP, Wabwire-Mangen F, Bangsberg DR. Incomplete adherence among treatment-experienced adults on antiretroviral therapy in Tanzania, Uganda and Zambia. AIDS. 2015 Jan 28; 29(3):361-71
Description
Author's version of a work that was subsequently published in AIDS, 2015 January 28; 29(3): 361-371. doi: 10.1097/QAD.0000000000000543. Published by Lippincott, Williams & Wilkins for the International AIDS Society.
At the time of writing, David Bangsberg was affiliated with Massachusetts General Hospital.