Field Adherence to Highly Active Antiretroviral Therapy in HIV-Infected Adults in Abidjan, Cote d'Ivoire

Université Victor Segalen Bordeaux 2, Burdeos, Aquitaine, France
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 07/2007; 45(3):355-8. DOI: 10.1097/QAI.0b013e31805d8ad0
Source: PubMed


To estimate adherence to highly active antiretroviral therapy (HAART) and its determinants in HIV-infected adults followed in field conditions in Abidjan.
A standardized questionnaire was administered to all consecutive adults on HAART who attended 3 urban HIV outpatient clinics. Patients were asked to self-report their pill intake during the previous 7 days, and, when necessary, to explain the reason(s) why they missed at least 1 intake. The adherence rate was estimated as the number of pills actually taken divided by the number of pills that should have been taken. The association of incomplete adherence (adherence rate<90%) with patients' characteristics was studied using multivariate logistic regression.
Three hundred eight patients (male/female ratio: 1:1, mean time on HAART: 22 months) were interviewed. The median self-reported adherence rate was 78% (interquartile range: 65%-90%), with 76% of patients considered as incompletely adherent (adherence rate<90%). The most frequent self-reported reasons for missing at least 1 intake were an antiretroviral drug being out of stock in the clinic pharmacy (28%), the fear of drug side effects (27%), the impossibility of paying the drug's price (20%), and the intervention of traditional practitioners (18%). The only variables significantly independently associated with incomplete adherence were a school level>or=secondary (odds ratio [OR]=1.88; P=0.03) and the absence of a patient's long-term formal commitment to adhere to HAART (OR=3.08; P=0.01).
These data illustrate the difficulty in obtaining high levels of adherence in field conditions in Abidjan. Sustainable access to treatment should be promoted by combating access barriers such as running out of drugs and costs that are too high.

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    • "Without high levels of adherence, there may be a rapid emergence of resistant mutations with resultant treatment failure, re-emergence of opportunistic infections and disease progression (Sethi, Celentano, Gange, Moore, & Gallant, 2003; Stubbs, Micek, Pffeiffer, Montay, & Gloyd, 2009). Despite the enormous benefits of sustained adherence, studies in adults indicate that adherence to ART is frequently below 80% (Eholie et al., 2007; Iliyasu, Kabir, Abubakar, Babashani, & Zubair, 2005; Mills et al., 2006). In children too, sub-optimal adherence is reported even from resource-rich nations of the world (Steele & Grauer, 2003). "
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    ABSTRACT: The objective of this study is to assess adherence to antiretroviral therapy (ART) in HIV-infected children using the pill count method, and determine factors leading to adherence failure. Records of 106 children living with HIV (CLHIV) age <15 years and on ART for >6 months were reviewed. Average adherence to ART by pill count method over preceding six months was calculated and re-assessed by 3-day recall method. The caregivers of 105 children and one child himself were interviewed about the problems encountered while giving ART. Median age of enrolled children was 104 (inter-quartile range [IQR] 77.3-133.8) months. Median duration of ART was 25 (IQR 16-35) months. The desired adherence level of >95% during six months of review assessed by pill count was achieved in 95.3% children. The 3-day recall method yielded >95% adherence in 99% children (p ≤ .001). Caregivers of 59 children (56.2%) reported multiple problems while administering drugs. In most instances, problems encountered were related to family/caregivers, the commonest being multiple caregivers, job constraints and death/illness in the family. In conclusion, we found a very high level of adherence to ART in CLHIV. Poor adherence was mainly associated with issues related to the family/caregivers.
    AIDS Care 11/2013; 26(7). DOI:10.1080/09540121.2013.859649 · 1.60 Impact Factor
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    • "In HIV-infected persons, good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes and improved quality of life with reduced morbidity and mortality [1-3]. Poor ART adherence is associated with perceived HIV stigma among patients receiving ART [4], being single (never married) and belief in divine spiritual healing in Uganda [5,6], and in Cote d’Ivoire, fear of treatment side effects and use of traditional healers [7]. Good ART adherence was associated with formal education level in Nigeria [8] and concerns for family well being in Uganda [9]. "
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    ABSTRACT: Background In HIV-infected persons, good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes. Patients’ worries before starting ART may affect their ART adherence and treatment outcomes. Methods Between 2004 and 2009, HIV-infected individuals in a prospective cohort study in rural Uganda were assessed for ART eligibility. A counsellor explained the ART eligibility criteria, adherence and side effects, and recorded the patients’ worries related to ART. Every quarter, patients who initiated ART had clinical, immunological (CD4 cell counts) and virological (viral loads) assessments, and data were collected on ART adherence using patients’ self-reports and pill counts. We describe the patients’ worries and examine their association with ART adherence, and immunological and virological outcomes. Results We assessed 421 patients, 271 (64%) were females, 318 (76%) were aged 30 years and above and 315 (75%) were eligible for ART. 277 (66%) reported any worry, and the proportions were similar by sex, age group and ART eligibility status. The baseline median CD4 counts and viral loads were similar among patients with any worry and those with no worry. The commonest worries were: fear of HIV serostatus disclosure; among 69 (16%) participants, lack of food when appetite improved after starting ART; 50 (12%), concurrent use of other medications; 33 (8%), adherence to ART; 28 (7%) and problems concerning condom use; 27 (6%). After 24 months or more on ART, patients who reported any worry had made more scheduled ART refill visits than patients who reported no worry (p<0.01), but the annual CD4 cell increases were similar (p=0.12). After one year on ART, patients who reported any worry had greater virological suppression than patients who reported no worry (p<0.05). Conclusions Despite the lack of significant associations of worries with unfavourable ART outcomes, physicians and counsellors should assist patients in overcoming their worries that can cause stress and discomfort. Food supplements may be desirable for some patients initiating ART.
    BMC Research Notes 05/2013; 6(1):187. DOI:10.1186/1756-0500-6-187
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    • "The current study assessed non-adherence and factors associated with it in Nairobi, Kenya. Prevalence of non-adherence found in this study (18%) is comparable to the continental prevalence (23%) for Africa [1], 21% in Southwest Ethiopia [2] and 22% in Cote d'Ivore [3]. But, inconsistent with the findings of Ellis et al. in Kibera, Nairobi (48%) [12]; Talam et al. in Eldoret (56.8%) [13] and Munyao et al. in Mombasa [14]. "
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    ABSTRACT: Antiretroviral therapy (ART) requires high-level (> 95%) adherence. Kenya is rolling out ART access programmes and, issue of adherence to therapy is therefore imperative. However, published data on adherence to ART in Kenya is limited. This study assessed adherence to ART and identified factors responsible for non adherence in Nairobi. This is a multiple facility-based cross-sectional study, where 416 patients aged over 18 years were systematically selected and interviewed using a structured questionnaire about their experience taking ART. Additional data was extracted from hospital records. Patients were grouped into adherent and non-adherent based on a composite score derived from a three questions adherence tool developed by Center for Adherence Support Evaluation (CASE). Multivariate regression model was used to determine predictors of non-adherence. Overall, 403 patients responded; 35% males and 65% females, 18% were non-adherent, and main (38%) reason for missing therapy were being busy and forgetting. Accessing ART in a clinic within walking distance from home (OR = 2.387, CI.95 = 1.155-4.931; p = 0.019) and difficulty with dosing schedule (OR = 2.310, CI.95 = 1.211-4.408, p = 0.011) predicted non-adherence. The study found better adherence to HAART in Nairobi compared to previous studies in Kenya. However, this can be improved further by employing fitting strategies to improve patients' ability to fit therapy in own lifestyle and cue-dose training to impact forgetfulness. Further work to determine why patients accessing therapy from ARV clinics within walking distance from their residence did not adhere is recommended.
    AIDS Research and Therapy 12/2011; 8(1):43. DOI:10.1186/1742-6405-8-43 · 1.46 Impact Factor
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