Adherence to Antiretroviral Therapy in HIV-Infected Adults in Soweto, South Africa

Abstract

Little is known about achievable levels of antiretroviral treatment (ART) adherence in resource-limited settings. We conducted a cross-sectional study of adherence among patients at Chris Hani Baragwanath Hospital's Adult HIV Clinic in Soweto, South Africa. Adherence was assessed using a 1-month, self-report questionnaire and was calculated as a ratio of doses taken to doses prescribed. The 66 patients studied had a mean age of 36.1 years, a median duration of ART use of 18 months, and an overall baseline median CD4(+) cell count of 200/mm(3) (IQR: 114-364). The adherence reported by these patients for the previous month was >95% for 58 patients (88%), 90-95% for 6 (9%) and, < 90% for 2 (3%). The main reasons given for missing doses were being away from home (30%), difficulty with the dosing schedules (23%), and running out of pills (12%). Adherence decreased considerably with fear of being stigmatized by the sexual partner (OR = 0.13 95%, CI 0.02-0.70). Plasma HIV RNA levels were <400 copies/ml in the majority of patients (73% of those with adherence >95% and 88% of patients with < or =95% adherence) and the overall median CD4(+) cell count rose to 324/mm(3) (IQR: 193-510). High adherence and viral suppression are achievable for a significant proportion of HIV-infected patients taking ART in a resource-limited area such as Soweto, South Africa. Strategies to maximize adherence in this setting should emphasize ready access to affordable and simple ART regimens, as well as HIV education programs to help increase awareness and decrease disease stigmatization.

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

“…These high levels of adherence confirm findings in other resource-limited settings (Byakika-Tusiime et al 2005;Fong et al 2003;Landman et al 2003;Laniece et al 2003;Laurent et al 2004;Laurent et al 2005a, b;Nachega et al 2004;Orrell et al 2003;Oyugi et al 2004;Remien et al 2003;Weidle et al 2002;Weiser et al 2003). Our findings contrast with those of Merenstein et al (2008), who found an inverse relationship between adherence and the number of children in the family.…”

“…Provision of no-cost therapy to all eligible HIV-infected individuals in the household ensured sustained adherence. As has been reported in other studies (Mills et al 2006a;Nachega et al 2004;Weiser et al 2003), perceived stigma was commonly reported as a barrier to access and adherence to ART.…”

“…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.…”

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

“…39 Failure to disclose one's HIV status to a partner is associated with stigma, which has been shown to hinder adherence. 4 A study in India found that reminders from family members, an indirect indicator that disclosure had occurred, were associated with better adherence outcomes. 40 Provision of couple HIV counseling and testing and community education encouraging disclosure may improve adherence.…”

“…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.…”