Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea

Abstract

Adherence to antiretroviral therapy (ART) is paramount for virological suppression and positive treatment outcomes. ART has been rapidly scaled up in Papua New Guinea (PNG) in recent years, however clinical monitoring of HIV+ individuals on ART is limited. A cross-sectional study was conducted at two major sexual health clinics in high HIV prevalence provinces in the Highlands Region of PNG to assess ART adherence, factors affecting adherence and the relationship between ART adherence and virological outcomes. Ninety-five HIV+ individuals were recruited and administered a questionnaire to gather demographic and ART adherence information whilst clinical data and pill counts were extracted from patient charts and blood was collected for viral load testing. Bivariate analysis was performed to identify independent predictors of ART adherence. Fourteen percent (n = 12) of participants showed evidence of virological failure. Although the majority of participants self-reported excellent ART adherence in the last seven days (78.9%, 75/91), pill count measurements indicated only 40% (34/84) with >95% adherence in the last month. Taking other medications while on ART (p = 0.01) and taking ART for ≥1 year (p = 0.037) were positively associated with adherence by self-report and pill count, respectively. Participants who had never heard of drug resistance were more likely to show virological failure (p = 0.033). Misconception on routes of HIV transmission still persists in the studied population. These findings indicate that non-adherence to ART is high in this region of PNG and continued education and strategies to improve adherence are required to ensure the efficacy of ART and prevent HIV drug resistance.

The Prevalence of HIV Load Suppression and Related Factors Among Patients on ART at Phedisong 4 Clinic, Pretoria, South Africa

“…The higher viral load suppression among men was also observed in a multi-center cohort study in Canada that found the male sex as one of the predictors of the likelihood of viral load suppression [29]. The failure of viral load suppression in 8/98 (8%) was comparable to the cross-sectional study from Papua New Guinea by Gare et al where evidence of virological failure was shown in 12/95 (12%) of their patients [30].…”

Baseline CD4 Count and Adherence to Antiretroviral Therapy: A Systematic Review and Meta-Analysis

“…The majority of studies (18) were from low-income and middle-income countries. [20][21][22]24,25,[27][28][29][30][33][34][35][40][41][42][43][44]46 Studies provided data for 72,119 participants, sample sizes ranged from 76 to 3700 adults, with 31,011 men and 40,669 women included (1 study did not disaggregate data by sex). 46 Median baseline CD4 count ranged from 104 to 486 cells per microliter and was FIGURE 2.…”

Prevalence of the Nursing Diagnosis Lack of Adherence in People Living with AIDS

“…In this sense, the dialogue with the health professionals is fundamental to the understanding of the treatment system to all doubts of patients be resolved [21]. Moreover, HAART patients need to be encouraged to understand the mechanisms of the disease so that they can adapt to necessary changes in regular and continuous use of therapy and be aware of the requirements that make the complex treatment [22].…”

“…Prolonged duration of the system also interfere negatively in membership in view of the changes resulting from prolonged use of therapy. Study found that some changes caused by the use of prolonged treatment, such as anemia, renal complications, metabolic and lipodystrophy were factors related to the abandonment of treatment and consequent lack of membership [22].…”

“…With regard to financial barriers, problems of economic order are generally more important for people living with AIDS than the urgency to take care of health [22]. The lack of financial conditions also interferes with the feed once the therapeutic treatment requires a balanced diet to minimize side effects, being a negative accession therapy [18]- [20].…”