Adherence to Early Antiretroviral Therapy

Abstract

Background Combination antiretroviral therapy (ART) for HIV-1 infected individuals prevents sexual transmission if viral load is suppressed. Methods Participants were HIV-1 infected partners randomized to early ART (CD4 350-550) in HPTN052 (n=886, median follow-up = 2.1 years), a clinical trial of early ART to prevent sexual transmission of HIV-1 in serodiscordant couples at 13 sites in 9 countries. Adherence was assessed via pill-count (dichotomized at <95%) and via self-report items. Predictors of adherence were mental health and general health perceptions, substance use, binge drinking, social support, sexual behaviors, and demographics. Viral suppression was defined as HIV plasma viral load <400 copies/ml. Adherence counseling and couples counseling about safer sex was provided. Logistic and linear regression models using generalized estimating equation for repeated measurements were employed. Findings Via pill-count, 82% of participants were adherent at 1 month and 83.3% at 1 year. Mental health was the only psychosocial variable associated with adherence (pill-count OR=1.05: 95% CI: 1.00 – 1.11; self-report parameter estimate (b)=0.02, 95% CI: 0.01 –0.04), though regional differences emerged. Pill-count (OR=1.19, 95% CI: 1.10-1.30) and self-report (OR=1.42, 95% CI: 1.14-1.77) adherence were associated with viral suppression. Interpretation While adherence was high among individuals in stable relationships taking ART for prevention, mental health and adherence co-varied. Assessing and intervening on mental health in the context of promoting adherence to ART as prevention should be explored. Adherence and couples counseling, feedback about viral suppression, and/or altruism may also help explain the magnitude of adherence observed.

Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva

“…The current findings are consistent with evidence of Life-Steps being culturally adapted in other international contexts such as China (Shiu et al, 2013; Simoni et al, 2013) and being feasibly implemented using a task-sharing approach (Safren et al, 2014, 2015). We have demonstrated feasibility and acceptability with both the patients and adherence counsellors by showing that, with 5 days of training and direct supervision on 10 cases, adherence counsellors showed excellent fidelity to the intervention, as rated by an 18-item therapist rating scale (Safren et al, 2009).…”

“…Life-Steps is a brief evidence-based intervention to improve ART adherence that uses cognitive-behavioural principles (Safren et al, 1999, 2001). Life-Steps has been evaluated in resource-limited global contexts (Simoni et al, 2009, 2013), is potentially sustainable and scalable using a task-shifting approach (CDC, 2015; Papas et al, 2011) and has been used in international clinical trials in the AIDS Clinical Trials Group and the HIV Prevention Trials Network (Safren et al, 2014, 2015). …”

Use of peers to improve adherence to antiretroviral therapy: a global network meta‐analysis

“…Discontinuation or the lack of consistent long-term adherence to ART can lead to drug resistance, AIDS-related illnesses and death, and can increase the risk of forward transmission [1–3]. As low rates of adherence have been reported in both high-income and low-income settings [4], achieving and maintaining high rates of ART is a global concern.…”

Socioeconomic factors explain suboptimal adherence to antiretroviral therapy among HIV-infected Australian adults with viral suppression

“…This is important, as the purpose of initiating ART, for personal or public health benefit, may influence a patient’s likelihood for adherence. Recently, in a study of HIV serodiscordant couples investigating ART as prevention of HIV (HPTN 052), high levels of ART adherence by pill count and self-report were reported in those initiating ART as prevention [52]. Good mental health was the only factor significantly associated with optimal ART adherence.…”