Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru: a cross-sectional study

Abstract

Background There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). Methods This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann–Whitney test, Chi square test, and Yates correction. Results The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. Conclusions Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.

Levels of Adherence and Associated Factors Among Children on ART Over Time in Northwest, Ethiopia: Evidence from a Multicenter Follow-Up Study

“… 31 , 45 Moreover, the level of adherence to ART is also higher than the studies conducted in Peru (41.7%), and Brazil (71.6%). 46 , 47 On the other hand, this finding is lower than the studies conducted in Debre Birhan (95.5%) and Nepal (87.4%). 32 , 48 …”

“…This study showed that children having TB/HIV co-infection increase the level of poor adherence by 3.80 times than children without TB co-infection (AOR=3.80, 95% CI (1.41, 10.1)) which is in line with other studies. 43 , 47 This might be due to the summative effect of suffering from two chronic conditions, associated with stigma and discrimination that require clinical management for an entire life. In addition to this, medication for confection, treatment, and ART together can contribute to increased pill burden, drug–drug interactions, and more adverse drug effects, all of which are capable of hindering adherence to antiretroviral drugs.…”

Adherence and Its Associated Factors Among Adult HIV-Infected Patients on Antiretroviral Therapy in South Western Ethiopia, 2020

“…This finding is, however, better than in studies done in Nigeria (74.2%), 26 Yirgalem Hospital of Ethiopia (63.8%), 27 and Peru (41.7%). 28 The explanation for this variation, particularly from the study in Peru, may be differences in sample sizes, with a small sample being used in Peru, and differences in the tools used for assessing adherence.…”

HIV understanding, experiences and perceptions of HIV-positive men who have sex with men in Amazonian Peru: a qualitative study

“…A digitalised appointment system could assist in providing this service on a larger scale in Loreto [54]. Instruments to measure adherence should be developed [55].…”