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

Abstract

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.

Predictors of Nonadherence to Highly Active Antiretroviral Therapy Among HIV-Infected South Indians in Clinical Care: Implications for Developing Adherence Interventions in Resource-Limited Settings

“…Earlier studies from varying regional settings have identified psychological distress as a barrier to optimal adherence. 46,47 Further in-depth studies in this patient population are needed to understand the impact of psychological function on treatment adherence, and psychosocial interventions (e.g., cognitive behavioral therapy) should be examined. 48 Having sex is an important part of overall health and quality of life, including patients infected with HIV.…”

Adherence to highly active antiretroviral therapy in depressed patients with HIV/AIDS attending a Nigerian university teaching hospital clinic

“…10 A Ugandan study showed that adherence to ART declined over time and that factors such as lack of transportation and money, stigma, clinical response to therapy, drug packaging and cost may impact on adherence. 11 Long-term viral suppression requires consistent and high percentage adherence accompanied by optimal inter-dose intervals. Efforts to improve viral outcomes should address not only missed doses but wide variations in dose timing.…”

“…21 HIV increases the risk of developing major depression through a variety of mechanisms including: direct injury to subcortical areas of the brain; chronic stress; stigmatization; worsening social isolation; bereavement; debilitation; and intense demoralization. 22 Research suggests that co-morbid depression in patients with HIV/AIDS may be associated with reduced adherence to ART 11,[23][24][25][26][27] and furthermore with disease progression. 28,29 A study in Ethiopia found that patients who were not depressed were two times more likely to be adherent than those who were depressed, although the principal reasons given for skipping doses were simply forgetting, feeling ill, being busy and running out of medication.…”

The Importance of Social Ties in Sustaining Medication Adherence in Resource-Limited Settings

“…Conversely, one can take all doses in a timely fashion without persisting with the regimen for the entire prescribed duration of treatment. Second, studies of adherence to pharmacological treatment for chronic illnesses have documented declining dose-taking execution 22 and persistence 23 over time, and this bodes poorly for the long-term success of treatment scale-up for persons with uncurable but manageable chronic illnesses who face a lifetime of pill-taking. Third, depending on the pharmacokinetic properties of the specific medication under consideration, a high degree of punctuality in average dose-taking execution can still result in poor outcomes if the rare episodes of non-persistence (described variously as drug holidays, 9 treatment interruptions, 24 or non-permissible gaps 10 ) are sequentially concentrated in time.…”