Antiretroviral treatment adherence and its determinants in Sub-Saharan Africa: a prospective study at Yaounde Central Hospital, Cameroon

Abstract

BackgroundWith African health-care systems facing exploding demand for HIV care, reliable methods for assessing adherence and its influencing factors are needed to guide effective public-health measures. This study evaluated individual patient characteristics determining antiretroviral treatment (ART) adherence and the predictive values of different measures of adherence on virological treatment failure in a cohort of patients in a routine-care setting in Cameroon.MethodsLongitudinal study over 6-months following ART introduction, using patients questionnaires and hospital and pharmacy records.ResultsAt the end of the 6 months study period, 219 of 312 patients (70%) returned to the pharmacy to refill their medication, 17% (51) were lost to follow-up, 9% (28) were dead and 4% (14) were transferred to other care centres. Virological treatment failure at 6 months was experienced by 26 patients, representing 13% of patients with available viral load value. Pharmacy refill irregularity was the most powerful predictor (odds ratio 12.4; P < 0.001) of virological treatment failure, compared with CD4 cell count increase at 6 months (odds ratio 7.8; P = 0.002) or self-reported adherence at one month (odds ratio 1.1; P = 0.85). Low intensity of ART side-effects after one month was strongly associated with survival (odds ratio 0.11; P = 0.001). Patients starting ART with CD4 cell count <100 cells/mm3 had a greater risk of dying during the follow-up period (odds ratio 2.69; P = 0.02). Compared with asymptomatic CDC stage A patients, CDC stage B (odds ratio 5.72) and CDC stage C patients (odds ratio 16.9) had higher risk of becoming lost to follow-up (P < 0.001). In the multivariate analyses, pharmacy non-adherence was less frequent in women (adjusted odds ratio 0.56; P = 0.05) but more frequent in patients with high monthly income (odds ratio 3.24; P = 0.04).ConclusionPharmacy-refill adherence might be considered as an alternative to CD4 count monitoring for identification of patients at risk of virological failure, especially in resources-scarce countries. The study confirmed the difficulty in demonstrating clear associations of individual patient factors and treatment outcomes. The substantial loss to follow-up and deaths occurring within 6 months after initiating ART emphasise the need to understand the best timing of ART initiation and further elucidate and educate on the underlying reasons for delaying initiation of ART in resource-limited countries

Toxoplasma antibodies amongst HIV/AIDS patients attending the University Teaching Hospital Yaounde in Cameroon

“…This can be surely attached to their failing immune system increasing the patient's vulnerability and the fact that IgG-antibodies last longer than IgM-antibodies. It is therefore possible most of the toxoplasmosis cases in HIV/AIDS are due to a reactivated infection (18). A 3/5 ratio of male to females (p>0.05) did not provide enough statistic evidence that positivity of toxoplasma antibodies is not sex dependent.…”

Antiretroviral treatment adherence and associated factors among people living with HIV in developing country, Myanmar

“…The respondents of more than 40 years of age were significantly less likely to adhere ART in this study although several studies reported that there is no consistent correlation between demographic characteristics and level of adherence. 24,25 Many potentially debilitating adverse effects of ART have also been shown to contribute to irregular taking of the drugs and deliberately stopping of medication by some patients. 26 The results of current study revealed that the side effect of ART was not associated with ART adherence.…”

Antiretroviral Treatment Interruption and Loss to Follow-Up in Two HIV Cohorts in Australia and Asia: Implications for ‘Test and Treat’ Prevention Strategy

“…[15][16][17][18][19] Of the few studies that have estimated the extent of TIs (including loss to follow-up; LTFU) since the SMART study; none compared pre-2006 to 2006 onwards, none measured the impact of the TI on HIV viral load or CD4 count, all defined TI using an interval of less than 4 weeks and thus included interruptions where viral load may not have been high enough to result in HIV transmission, and all were conducted in Africa or the United States. [20][21][22][23][24] The aim of this study was to investigate the incidence, frequency of TIs and LTFU pre and post 2006, risk factors for TI, and the impact of TI on plasma HIV viral load across 13 countries covering both high and low-income settings in Asia and the Pacific.…”