Adherence to antiretroviral therapy (ART) during the early months of treatment in rural Zambia: influence of demographic characteristics and social surroundings of patients

Abstract

BackgroundAround 70% of those living with HIV in need of treatment accessed antiretroviral therapy (ART) in Zambia by 2009. However, sustaining high levels of adherence to ART is a challenge. This study aimed to identify the predictive factors associated with ART adherence during the early months of treatment in rural Zambia.MethodsThis is a field based observational longitudinal study in Mumbwa district, which is located 150 km west of Lusaka, the capital of Zambia. Treatment naive patients aged over 15 years, who initiated treatment during September-November 2010, were enrolled. Patients were interviewed at the initiation and six weeks later. The treatment adherence was measured according to self-reporting by the patients. Multiple logistic regression analysis was performed to identify the predictive factors associated with the adherence.ResultsOf 157 patients, 59.9% were fully adherent to the treatment six weeks after starting ART. According to the multivariable analysis, full adherence was associated with being female [Adjusted Odds Ratio (AOR), 3.3; 95% Confidence interval (CI), 1.2-8.9], having a spouse who were also on ART (AOR, 4.4; 95% CI, 1.5-13.1), and experience of food insufficiency in the previous 30 days (AOR, 5.0; 95% CI, 1.8-13.8). Some of the most common reasons for missed doses were long distance to health facilities (n = 21, 53.8%), food insufficiency (n = 20, 51.3%), and being busy with other activities such as work (n = 15, 38.5%).ConclusionsThe treatment adherence continues to be a significant challenge in rural Zambia. Social supports from spouses and people on ART could facilitate their treatment adherence. This is likely to require attention by ART services in the future, focusing on different social influences on male and female in rural Zambia. In addition, poverty reduction strategies may help to reinforce adherence to ART and could mitigate the influence of HIV infection for poor patients and those who fall into poverty after starting ART.

Factors Influencing Adherence to Antiretroviral Therapy among People Living with HIV in Coastal South India

“…The adherence rate was better in our settings compared to some studies [18][19][20] ; however, other studies conducted elsewhere have shown higher adherence to ART compared to our study findings. 10,12,[21][22][23][24][25][26][27] Better adherence in our settings could be due to the fact that all PLHIV receive free ART, regular adherence monitoring, and better literacy rate and awareness about HIV disease in coastal South India.…”

Factors Associated with Non-Adherence to Antiretroviral Treatment in Adults at Keetmanshoop District State Hospital in Namibia

“…Other factors which were statistically insignificant in this study were; ethnicity, religion, marital status, level of education, living condition and source of support. Although in some studies association between marital status and adherence levels were also not established, in Zambia unmarried people were found more non-adherent [8,10,11]. Similarly, some studies did not yield any association between education level and adherence levels, but others have documented significance [8,10,12,13].…”

The Psychosocial Factors that Influencing HIV-AIDS Antiretroviral Treatment Adherence

“…Notably, the efficacy of any treatment depends on sustained high levels of adherence to ART. But ART regimens are often According to WHO, the interventions target adherences was tailored to the demands that experienced by the patients with that specific illness [7]. As a result, it is important for health care providers to assess those factors that impact negatively on adherence.…”

“…If there is poor adherence then there is a higher risk that drug resistance will develop, which will result in need for second-line drug treatment. When people living with HIV require second line treatment, it can be ten times more expensive than first line drugs [7].…”