Adherence to Antiretroviral Treatment in HIV-Positive Patients in the Cameroon Context: Promoting the Use of Medication Reminder Methods

INSERM, U912, SE4S, Marseille, Bouches-du-Rhône, France.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.56). 07/2011; 57 Suppl 1(6s):S40-3. DOI: 10.1097/QAI.0b013e318222b5c2
Source: PubMed


Antiretroviral treatment (ART) scale-up in sub-Saharan Africa has made it possible to investigate the maintenance of adherence to HIV medications. We describe here adherence to ART and identify its correlates in the Cameroonian context.
Prospective cohort study in 9 rural district hospitals.
A mixed logistic regression model was used to identify factors associated with adherence to ART in 401 patients with data prospectively collected on adherence.
Although 73% of patients were adherent after the first month on ART, this proportion decreased to 61% after 24 months. After adjustment for known factors of adherence to ART (such as knowledge, motivation and side-effects), patients who reported willingness to start ART before initiation, those who were satisfied with information provided by their physicians, and those who implemented reminder methods for ART intake {eg, using an alarm clock, mobile phone, or watch [odds ratio (95% confidence interval)] = 2.45 (1.58 to 3.79), but also the help of a relative to remind them or other methods} were more likely to be adherent to ART.
Besides highlighting some correlates already known to have an impact on adherence to ART, our findings also underline the need to reinforce the counseling component of follow-up through innovative methods. Accordingly, training and implementation research should encourage the use of medication reminder methods, such as mobile phones, to assure adherence over time and improve long-term response to ART.

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    • "Simply forgetting was cited as the most common reason for ever missing ART, a result which concurs with findings from other studies.192021Advances in mHealth technologies are emerging as an option to address forgetting to take ART. For example, several studies have found that patients who received text messages have better levels of ART adherence and clinical indicators, such as lower viral loads and higher CD4 cell counts, compared to patients who did not receive text messages.222324However, in their network meta-analysis examining direct and indirect evidence from randomized trials, Mills and colleagues found a large benefit for weekly but not for daily SMS messages[25], emphasizing the need for tailored mHealth inter- ventions.[26]Such findings support the inclusion of mobile phone text messaging in the package of adherence intervention tools, as recommended by the World Health Organization in their latest guidelines, as well as the need for more research on how to optimize the use of text messaging.[27]However, "
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    ABSTRACT: Objectives: To identify the reasons patients miss taking their antiretroviral therapy (ART) and the proportion who miss their ART because of symptoms; and to explore the association between symptoms and incomplete adherence. Methods: Secondary analysis of data collected during a cross-sectional study that examined ART adherence among adults from 18 purposefully selected sites in Tanzania, Uganda, and Zambia. We interviewed 250 systematically selected patients per facility (≥18 years) on reasons for missing ART and symptoms they had experienced (using the HIV Symptom Index). We abstracted clinical data from the patients' medical, pharmacy, and laboratory records. Incomplete adherence was defined as having missed ART for at least 48 consecutive hours during the past 3 months. Results: Twenty-nine percent of participants reported at least one reason for having ever missed ART (1278/4425). The most frequent reason was simply forgetting (681/1278 or 53%), followed by ART-related hunger or not having enough food (30%), and symptoms (12%). The median number of symptoms reported by participants was 4 (IQR: 2-7). Every additional symptom increased the odds of incomplete adherence by 12% (OR: 1.1, 95% CI: 1.1-1.2). Female participants and participants initiated on a regimen containing stavudine were more likely to report greater numbers of symptoms. Conclusions: Symptoms were a common reason for missing ART, together with simply forgetting and food insecurity. A combination of ART regimens with fewer side effects, use of mobile phone text message reminders, and integration of food supplementation and livelihood programmes into HIV programmes, have the potential to decrease missed ART and hence to improve adherence and the outcomes of ART programmes.
    Full-text · Article · Jan 2016 · PLoS ONE
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    • "SMS, video messages (MMS) and phone calls were used on these projects. Other findings included a cross-sectional study exploring the feasibility of using mobile phones for sending reminders to patients regarding their medications and appointments in an antiretroviral treatment (ART) health facility [28], a review to determine effectiveness of SMS on patient adherence to ART [29], a cohort study to monitor patient adherence to ART [30], and two mixed-methods studies, one for supporting patients with breast cancer during their oncological treatment [31] and a second one to monitor adherence to treatment and care provided by caregivers of HIV-infected children [32]. "
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    ABSTRACT: Access to mobile phone technology has rapidly expanded in developing countries. In Africa, mHealth is a relatively new concept and questions arise regarding reliability of the technology used for health outcomes. This review documents strengths, weaknesses, opportunities, and threats (SWOT) of mHealth projects in Africa. A systematic review of peer-reviewed literature on mHealth projects in Africa, between 2003 and 2013, was carried out using PubMed and OvidSP. Data was synthesized using a SWOT analysis methodology. Results were grouped to assess specific aspects of project implementation in terms of sustainability and mid/long-term results, integration to the health system, management process, scale-up and replication, and legal issues, regulations and standards. Forty-four studies on mHealth projects in Africa were included and classified as: "patient follow-up and medication adherence" (n = 19), "staff training, support and motivation" (n = 2), "staff evaluation, monitoring and guidelines compliance" (n = 4), "drug supply-chain and stock management" (n = 2), "patient education and awareness" (n = 1), "disease surveillance and intervention monitoring" (n = 4), "data collection/transfer and reporting" (n = 10) and "overview of mHealth projects" (n = 2). In general, mHealth projects demonstrate positive health-related outcomes and their success is based on the accessibility, acceptance and low-cost of the technology, effective adaptation to local contexts, strong stakeholder collaboration, and government involvement. Threats such as dependency on funding, unclear healthcare system responsibilities, unreliable infrastructure and lack of evidence on cost-effectiveness challenge their implementation. mHealth projects can potentially be scaled-up to help tackle problems faced by healthcare systems like poor management of drug stocks, weak surveillance and reporting systems or lack of resources. mHealth in Africa is an innovative approach to delivering health services. In this fast-growing technological field, research opportunities include assessing implications of scaling-up mHealth projects, evaluating cost-effectiveness and impacts on the overall health system.
    Full-text · Article · Feb 2014 · BMC Public Health
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    • "Indeed, participation in a PLWHA association, which we found to be associated with decreased risk of non-adherence and having a detectable viral load, may encourage positive behaviour among patients on ART. Additionally, while use of reminder tools was not associated with self-reported adherence, their use was significantly associated with low odds of having a detectable viral load, providing further evidence that they promote adherence [38]–[40]. Women were also less likely to have a detectable viral load, consistent with a recent study from Uganda, but no gender differential was observed in reporting of non-adherence. This is consistent with data from a smaller study in Uganda [41] and suggests either a true sex difference in response to ART or misreporting of adherence among men. "
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    ABSTRACT: Generalizable data are needed on the magnitude and determinants of adherence and virological suppression among patients on antiretroviral therapy (ART) in Africa. We conducted a cross-sectional survey with chart abstraction, patient interviews and site assessments in a nationally representative sample of adults on ART for 6, 12 and 18 months at 20 sites in Rwanda. Adherence was assessed using 3- and 30-day patient recall. A systematically selected sub-sample had viral load (VL) measurements. Multivariable logistic regression examined predictors of non-perfect (<100%) 30-day adherence and detectable VL (>40 copies/ml). Overall, 1,417 adults were interviewed and 837 had VL measures. Ninety-four percent and 78% reported perfect adherence for the last 3 and 30 days, respectively. Eighty-three percent had undetectable VL. In adjusted models, characteristics independently associated with higher odds of non-perfect 30-day adherence were: being on ART for 18 months (vs. 6 months); younger age; reporting severe (vs. no or few) side effects in the prior 30 days; having no documentation of CD4 cell count at ART initiation (vs. having a CD4 cell count of <200 cells/µL); alcohol use; and attending sites which initiated ART services in 2003-2004 and 2005 (vs. 2006-2007); sites with ≥600 (vs. <600 patients) on ART; or sites with peer educators. Participation in an association for people living with HIV/AIDS; and receiving care at sites which regularly conduct home-visits were independently associated with lower odds of non-adherence. Higher odds of having a detectable VL were observed among patients at sites with peer educators. Being female; participating in an association for PLWHA; and using a reminder tool were independently associated with lower odds of having detectable VL. High levels of adherence and viral suppression were observed in the Rwandan national ART program, and associated with potentially modifiable factors.
    Full-text · Article · Jan 2013 · PLoS ONE
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