Adherence to antiretroviral therapy in a home-based AIDS care programme in rural Uganda

Weidle, Paul J.; Wamai, Nafuna; Solberg, Peter; Liechty, Cheryl; Sendagala, Sam; Were, Willy; Mermin, Jonathan; Buchacz, Kate; Behumbiize, Prosper; Ransom, Ray; Bunnell, Rebecca

doi:10.1016/s0140-6736(06)69118-6

Cited by 208 publications

(196 citation statements)

References 23 publications

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“…The hospital started its ART program in December 2004 and receives support from the following 2 sources: (1) Timetable for Regional Expansion of Antiretroviral Therapy (TREAT), the US President's Plan for AIDS Relief (PEPFAR)-funded program of the Joint Clinical Research Centre; and (2) the ART program of the Ugandan Ministry of Health, which is supported by the Global Fund to Fight AIDS, Tuberculosis, and Malaria. Patients are initiated on ART if they are considered to have World Health Organization (WHO) clinical stages 3 or 4 disease and/or total lymphocyte count <1500 cells/mm 3 . First-line therapy is a fixed-dose combination of stavudine (d4T) þ lamivudine (3TC) þ nevirapine (NVP).…”

Section: Methods Settingmentioning

confidence: 99%

“…1 Most formal evaluations have been of ART programs in large urban hospitals 2 or from donor-funded homebased programs. 3 Antiretroviral therapy adherence has also been reported predominantly among patients in the context of urban [4][5][6] and research settings. 7 Few studies have evaluated government-based ART programs, serving rural populations where the structural-and patient-level barriers to successful treatment response are unique.…”

Section: Introductionmentioning

confidence: 99%

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Adherence and Treatment Response Among HIV-1-Infected Adults Receiving Antiretroviral Therapy in a Rural Government Hospital in Southwestern Uganda

Bajunirwe

Arts

Tisch

et al. 2009

Journal of the International Association of Physicians in AIDS

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Background. Large-scale, government-based antiretroviral therapy (ART) programs in rural areas of resource-poor countries remain largely unevaluated. Methods. We conducted a retrospective review of all patients receiving ART (n ¼ 399) to assess survival and retention in care and a prospective evaluation of patients on ART for at least 6 months (n ¼ 175). We used 3-day self-report to measure adherence. Results. The probability (95% confidence interval [CI]) of surviving and remaining in care was 0.76 (0.72, 0.81) at 1 year. Men and patients with advanced disease were more likely to die or be lost to follow-up. At baseline, 149 (85%) reported 100% adherence. Nonadherence was associated with lack of suppression of viral replication (odds ratio [OR] ¼ 4.5; 95% CI: 1.8, 11.5). Missing a scheduled clinic visit and lack of disclosure of HIV status were associated with nonadherence. Conclusion. Viral suppression was high, but counseling to include HIV disclosure to family and keeping scheduled clinic appointments may improve long-term adherence and treatment outcomes.

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Section: Methods Settingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Adherence and Treatment Response Among HIV-1-Infected Adults Receiving Antiretroviral Therapy in a Rural Government Hospital in Southwestern Uganda

Bajunirwe

Arts

Tisch

et al. 2009

Journal of the International Association of Physicians in AIDS

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“…While most studies have shown high levels of adherence to ART in resource-constrained settings Bisson et al 2008;Byakika-Tusiime et al 2005;Diabate et al 2007;Etard et al 2007;Fong et al 2003;Landman et al 2003;Laniece et al 2003;Laurent et al 2004;Laurent et al 2005a, b;Mills et al 2006b;Nachega et al 2004;Orrell et al 2003;Oyugi et al 2004;Remien et al 2003;San Lio et al 2008;Tadios and Davey 2006;Weidle et al 2002;Weidle et al 2006;Weiser et al 2003) there has been little discussion about how HIV? women balance the demands of adherence to HIV ART, childcare, and antiretroviral adherence among their children who are HIV-infected.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Antiretroviral Adherence in HIV+ Ugandan Parents and Their Children Initiating HAART in the MTCT-Plus Family Treatment Model: Role of Depression in Declining Adherence Over Time

et al. 2009

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We conducted a study to assess the effect of family-based treatment on adherence amongst HIV-infected parents and their HIV-infected children attending the Mother-To-Child-Transmission Plus program in Kampala, Uganda. Adherence was assessed using home-based pill counts and self-report. Mean adherence was over 94%. Depression was associated with incomplete adherence on multivariable analysis. Adherence declined over time. Qualitative interviews revealed lack of transportation money, stigma, clinical response to therapy, drug packaging, and cost of therapy may impact adherence. Our results indicate that providing ART to all eligible HIV-infected members in a household is associated with excellent adherence in both parents and children. Adherence to ART among new parents declines over time, even when patients receive treatment at no cost. Depression should be addressed as a potential barrier to adherence. Further study is necessary to assess the long-term impact of this family treatment model on adherence to ART in resource-limited settings.

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“…These strategies have mainly been evaluated in high-income countries. Most adherence studies in Africa have focused on home-based support, building self-efficacy and assessing ART costs and adherence (Diabate, Alary, & Koffi, 2007;Hardon et al, 2007;Mukherjee, Ivers, Leandre, Farmer, & Behforouz, 2006;Ramadhani et al, 2007;Simoni et al, 2008;Weidle et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Perceived stigma among patients receiving antiretroviral treatment: A prospective randomised trial comparing an m-DOT strategy with standard-of- care in Kenya

Kaai

Bullock

Sarna³

et al. 2010

SAHARA-J: Journal of Social Aspects of HIV/AIDS

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HIV and AIDS remain highly stigmatised. Modified directly observed therapy (m-DOT) supports antiretroviral treatment (ART) adherence but little is known about its association with perceived stigma in resource-constrained settings. In 2003, 234 HIV-infected adults enrolled in a two-arm randomised trial comparing a health centre-based m-DOT strategy with standard self-administration of ART. Data on perceived stigma were collected using Berger's HIV stigma scale prior to starting ART and after 12 months. This was a secondary analysis to examine whether perceived stigma was related to treatment delivery. Perceived stigma scores declined after 12 months of treatment from a mean of 44.9 (sd=7.6) to a mean of 41.4 (sd=7.7), (t=6.14, P<0.001). No differences were found between the mean scores of participants in both study arms. Also, no difference in scores was detected using GLM, controlling for socio-demographic characteristics and baseline scores. Findings indicate that a well managed clinic-based m-DOT does not increase perceived HIV-related stigma.

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Adherence to antiretroviral therapy in a home-based AIDS care programme in rural Uganda

Cited by 208 publications

References 23 publications

Adherence and Treatment Response Among HIV-1-Infected Adults Receiving Antiretroviral Therapy in a Rural Government Hospital in Southwestern Uganda

Adherence and Treatment Response Among HIV-1-Infected Adults Receiving Antiretroviral Therapy in a Rural Government Hospital in Southwestern Uganda

Longitudinal Antiretroviral Adherence in HIV+ Ugandan Parents and Their Children Initiating HAART in the MTCT-Plus Family Treatment Model: Role of Depression in Declining Adherence Over Time

Perceived stigma among patients receiving antiretroviral treatment: A prospective randomised trial comparing an m-DOT strategy with standard-of- care in Kenya

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