High Levels of Adherence and Viral Suppression in a Nationally Representative Sample of HIV-Infected Adults on Antiretroviral Therapy for 6, 12 and 18 Months in Rwanda

Abstract

BackgroundGeneralizable data are needed on the magnitude and determinants of adherence and virological suppression among patients on antiretroviral therapy (ART) in Africa.MethodsWe conducted a cross-sectional survey with chart abstraction, patient interviews and site assessments in a nationally representative sample of adults on ART for 6, 12 and 18 months at 20 sites in Rwanda. Adherence was assessed using 3- and 30-day patient recall. A systematically selected sub-sample had viral load (VL) measurements. Multivariable logistic regression examined predictors of non-perfect (<100%) 30-day adherence and detectable VL (>40 copies/ml).ResultsOverall, 1,417 adults were interviewed and 837 had VL measures. Ninety-four percent and 78% reported perfect adherence for the last 3 and 30 days, respectively. Eighty-three percent had undetectable VL. In adjusted models, characteristics independently associated with higher odds of non-perfect 30-day adherence were: being on ART for 18 months (vs. 6 months); younger age; reporting severe (vs. no or few) side effects in the prior 30 days; having no documentation of CD4 cell count at ART initiation (vs. having a CD4 cell count of <200 cells/µL); alcohol use; and attending sites which initiated ART services in 2003–2004 and 2005 (vs. 2006–2007); sites with ≥600 (vs. <600 patients) on ART; or sites with peer educators. Participation in an association for people living with HIV/AIDS; and receiving care at sites which regularly conduct home-visits were independently associated with lower odds of non-adherence. Higher odds of having a detectable VL were observed among patients at sites with peer educators. Being female; participating in an association for PLWHA; and using a reminder tool were independently associated with lower odds of having detectable VL.ConclusionsHigh levels of adherence and viral suppression were observed in the Rwandan national ART program, and associated with potentially modifiable factors.

Depression, adherence and attrition from care in HIV-infected adults receiving antiretroviral therapy

“…While the results of this study do not suggest that additional targeted adherence support for patients with depression would have improved HIV treatment outcomes in this cohort, it is noteworthy that all patients in this study were receiving care in Rwanda's National HIV programme, the success of which has been documented 39. Although our findings may be generalisable to other strong ART programmes with high adherence levels, in some settings adherence is most likely an important mediator between depression and attrition, and adherence-related support may represent an important intervention.…”

Trends in and correlates of CD4+ cell count at antiretroviral therapy initiation after changes in national ART guidelines in Rwanda

“…A global analysis of data from 48 countries, including those in North America, Europe, and SSA, found that in 2009 the United States had the highest mean CD4 + cell count at ART initiation (307 cells/µl) followed, remarkably, by Rwanda (287 cells/µl) [17,18]. Given this and other HIV programmatic scale-up successes in Rwanda [13,14,19], there are likely important lessons to be learned by comparing Rwanda’s experience with those of other countries in SSA.…”

“…With an HIV prevalence of 3.0% [11], Rwanda has been scaling up access to HIV care since 2004, and the mature national programme has achieved more than 93% ART coverage [12] with high rates of retention [13] and medication adherence with viral suppression [14]. We therefore examined the proportion of persons enrolling in HIV care and initiating ART in the advanced stages of HIV infection among patients in Kigali, Rwanda, before and after the first expansion of national ART guidelines from a CD4 + threshold of 200 cells/µl to 350 cells/µl.…”

Polyactin A increases CD4+ T-cell counts in HIV-infected individuals with insufficient immunologic response to highly active antiretroviral therapy

“…With a first-line HAART therapy or a salvage therapy, approximately 90% of HIV-infected patients have undetectable viral load. 13,14 However, some patients with sustained viral suppression were also found to have insufficient immunologic response, which may increase their risk of disease progression and death. 9,15 CD4 þ T-cell count serves as the major laboratory indicator of immune function in HIV/AIDS patients.…”