Factors affecting first-month adherence to antiretroviral therapy amongHIV-positive adults in South Africa

Abstract

This study explores the influence of baseline factors on first-month adherence to highly active antiretroviral therapy (HAART) among adults. The study design involved a review of routinely collected patient information in the CAPRISA AIDS Treatment (CAT) programme, at a rural and an urban clinic in KwaZulu-Natal Province, South Africa. The records of 688 patients enrolled in the CAT programme between June 2004 and September 2006 were analysed. Adherence was calculated from pharmacy records (pill counts) and patients were considered adherent if they had taken at least 95% of their prescribed drugs. Logistic regression was used to analyse the data and account for confounding factors. During the first month of therapy, 79% of the patients were adherent to HAART. HAART adherence was negatively associated with a higher baseline CD4 count. Women had better adherence if they attended voluntarily testing and counselling or if they had taken an HIV test because they were unwell, while men had higher adherence if they were tested due to perceived risk of HIV infection. HAART adherence was positively associated with higher age among patients who possessed cell phones and among patients who provided a source of income in the urban setting, but not in the rural setting. Though long-term data from this cohort is required to fully evaluate the impact of non-adherence in the first month of treatment, this study identifies specific groups of patients at higher risk for whom adherence counselling should be targeted and tailored. For example, first-month HAART adherence can be improved by targeting patients initiated on treatment with a high CD4 count.

Universal test and treat and the HIV epidemic in rural South Africa: a phase 4, open-label, community cluster randomised trial

“…Our cohort comprised individuals with a higher median CD4 count at ART initiation than in those studies and findings corroborate that seen in high income countries reported in the systematic review by Bock et al [17]. WHO recommends universal test and treat for HIV [1]; South Africa has already adopted this recommendation Using either adherence measure, men had more than double the odds of sub-optimal adherence compared with women, similar to findings reported in two studies in Tanzania [19] and South Africa [20]. We observed a high out-migration rate which was cyclical in nature within the TasP trial.…”

“…Adherence at each visit was plotted over the first 12 months after ART initiation; during this period, adherence was expected to be documented at 13 visits (2,4,8,12,16,20,24,28,32,36,40,44, 48 weeks post ART initiation). Random effects logistic regression was used to examine the association between CD4 count at initiation and sub-optimal adherence at each visit.…”

Determinants of non-adherence to antiretroviral therapy in adult hospitalized patients, Northwest Ethiopia

“…The results from this study demonstrated that age, the level of education achieved, employment or nonemployment, HIV disclosure to family, and comfortability in taking ART in the presence of others are the conditions that will effect ART adherence. This is contradictory to the finding of Maqutu et al33 However, demographic factors are closely linked to socioeconomic status, which encompasses access to resources such as educational opportunities, living conditions, social support, and health facilities, which are similarly observed in the literature of Rachlis et al’s review on livelihood and ART adherence at its early stage 34…”

Temporal trends in CD4-positive T-cell counts among AIDS patients in Tianjin, China: 2005–2016

“…Younger age, lower education, and lower income were all shown to be associated with worse therapeutic and immune responses due to the low frequency of adherence and poor access to healthcare services [20][21][22]. However, previous studies have also demonstrated that decreased adherence was associated with higher baseline CD4 counts [23][24][25][26][27][28][29].…”