Incomplete adherence among treatment-experienced adults on antiretroviral therapy in Tanzania, Uganda and Zambia

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.

Alcohol Interactive Toxicity Beliefs and ART Non-adherence Among HIV-Infected Current Drinkers in Mbarara, Uganda

“…Similar to other studies (2, 5, 6), unhealthy alcohol use was also associated with ART non-adherence in our multivariable model, although it did not reach statistical significance (Wald X 2 = 3.72; p-value = 0.054). This independent effect suggests that alcohol use may impact adherence in multiple ways, i.e.…”

Treatment Failure, Drug Resistance, and CD4 T-Cell Count Decline Among Postpartum Women on Antiretroviral Therapy in South Africa

“…These findings are slightly better than the 29% failure we observed at 12 months. Notably, these outcomes are worse than recent reports from general adult ART clinics ranging from 9 to 16% virologic failure [31-33]. Other pregnancy-related studies have reported a high rate of loss from follow-up, but have not included virologic outcomes [14, 16, 34].…”

Alcohol use and depression: link with adherence and viral suppression in adult patients on antiretroviral therapy in rural Lesotho, Southern Africa: a cross-sectional study

“…The amplitude of the effect of hazardous alcohol consumption on low adherence (adjusted OR 2.72) is higher to the one found in the literature: a meta-analysis published by Hendershot and colleagues in 2009 reported an OR of 1.82 [33]; Denison et al report a pooled OR of 1.87 [27], and Ayay et al 2.17 [30]. However, these studies did not examine for association with viral suppression.…”