Field adherence to highly active antiretroviral therapy in HIV-infected adults in Abidjan, Cote d'Ivoire
ABSTRACT 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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ABSTRACT: Background Adherence to combination antiretroviral therapy (ART) is a key predictor of the success of human immunodeficiency virus (HIV) treatment, and is potentially amenable to intervention. Insight into predictors or correlates of non-adherence to ART may help guide targets for the development of adherence-enhancing interventions. Our objective was to review evidence on predictors/correlates of adherence to ART, and to aggregate findings into quantitative estimates of their impact on adherence.Methods We searched PubMed for original English-language papers, published between 1996 and June 2014, and the reference lists of all relevant articles found. Studies reporting on predictors/correlates of adherence of adults prescribed ART for chronic HIV infection were included without restriction to adherence assessment method, study design or geographical location. Two researchers independently extracted the data from the same papers. Random effects models with inverse variance weights were used to aggregate findings into pooled effects estimates with 95% confidence intervals. The standardized mean difference (SMD) was used as the common effect size. The impact of study design features (adherence assessment method, study design, and the United Nations Human Development Index (HDI) of the country in which the study was set) was investigated using categorical mixed effects meta-regression.ResultsIn total, 207 studies were included. The following predictors/correlates were most strongly associated with adherence: adherence self-efficacy (SMD¿=¿0.603, P¿=¿0.001), current substance use (SMD¿=¿¿0.395, P¿=¿0.001), concerns about ART (SMD¿=¿¿0.388, P¿=¿0.001), beliefs about the necessity/utility of ART (SMD¿=¿0.357, P¿=¿0.001), trust/satisfaction with the HIV care provider (SMD¿=¿0.377, P¿=¿0.001), depressive symptoms (SMD¿=¿¿0.305, P¿=¿0.001), stigma about HIV (SMD¿=¿¿0.282, P¿=¿0.001), and social support (SMD¿=¿0.237, P¿=¿0.001). Smaller but significant associations were observed for the following being prescribed a protease inhibitor-containing regimen (SMD¿=¿¿0.196, P¿=¿0.001), daily dosing frequency (SMD¿=¿¿0.193, P¿=¿0.001), financial constraints (SMD ¿0.187, P¿=¿0.001) and pill burden (SMD¿=¿¿0.124, P¿=¿0.001). Higher trust/satisfaction with the HIV care provider, a lower daily dosing frequency, and fewer depressive symptoms were more strongly related with higher adherence in low and medium HDI countries than in high HDI countries.Conclusions These findings suggest that adherence-enhancing interventions should particularly target psychological factors such as self-efficacy and concerns/beliefs about the efficacy and safety of ART. Moreover, these findings suggest that simplification of regimens might have smaller but significant effects.BMC Medicine 08/2014; 12(1):142. DOI:10.1186/PREACCEPT-1453408941291432 · 7.28 Impact FactorThis article is viewable in ResearchGate's enriched formatRG Format enables you to read in context with side-by-side figures, citations, and feedback from experts in your field.
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ABSTRACT: : The predictors for seeking alternative therapies for HIV-infection in sub-Saharan Africa are unknown. Among a prospective cohort of 442 HIV-infected patients in Moshi, Tanzania, 249 (56%) sought cure from a newly popularized religious healer in Loliondo (450 km away), and their adherence to antiretrovirals (ARVs) dropped precipitously (odds ratio = 0.20, 95% confidence interval: 0.09 to 0.44, P < 0.001) after the visit. Compared with those not attending Loliondo, attendees were more likely to have been diagnosed with HIV more remotely (3.8 vs. 3.0 years before, P < 0.001), have taken ARVs longer (3.4 vs. 2.5 years, P < 0.001), have higher median CD4 lymphocyte counts (429 vs. 354 cells/mm, P < 0.001), be wealthier (wealth index: 10.9 vs. 8.8, P = 0.034), and receive care at the private versus the public hospital (P = 0.012). In multivariable logistic regression, only years since the start of ARVs remained significant (odds ratio = 1.49, 95% confidence interval: 1.23 to 1.80). Treatment fatigue may play a role in the lure of alternative healers.JAIDS Journal of Acquired Immune Deficiency Syndromes 03/2014; 65(3):e104-9. DOI:10.1097/01.qai.0000437619.23031.83 · 4.39 Impact Factor
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ABSTRACT: The increasing number of people requiring HIV treatment in South Africa calls for efficient use of its human resources for health in order to ensure optimum treatment coverage and outcomes. This paper describes an innovative public-private partnership model which uses private sector doctors to treat public sector patients and ascertains the model's ability to maintain treatment outcomes over time.PLoS ONE 10/2014; 9(10):e110635. DOI:10.1371/journal.pone.0110635 · 3.53 Impact Factor