Optimal HAART adherence over time and time interval between successive visits: their association and determinants

Abstract

We aimed to investigate the determinants of optimal highly active antiretroviral therapy (HAART) adherence and time interval between successive clinic visits, as well as the association between these two processes. This was done by reviewing routinely collected patient information in the Centre for the AIDS Programme of Research in South Africa (CAPRISA). Records of 688 patients enrolled in the CAPRISA AIDS treatment (CAT) programme between 2004 and 2006 were analysed. Patients were considered adherent if they had taken at least 95% of their prescribed drugs. The adherence has been measured using the pill counts data. A multivariate generalized mixed random effects approach was used to jointly analyse optimal HAART adherence and time interval between successive visits. The results showed that on the overall, the association between optimal HAART adherence and time interval between successive visits was negative. The results further showed that the interaction between time and treatment site had a significant joint effect on optimal HAART adherence and time interval between successive visits. The interaction revealed that as the number of follow-up visits increased, the interval between successive visits also increased while at the same time high levels of optimal adherence were maintained in the rural treatment site. Moreover, after accounting for the time interval between successive visits, the results showed that optimal HAART adherence was significantly associated with having a cell phone, living with a partner as well as interactions that include time and gender, time and treatment site, age and gender and age and education. The findings provide evidence of a negative association between optimal HAART adherence and the time interval between successive clinic visits on the overall, which therefore indicates that longer time interval between successive clinic visits is undesirable if optimal HAART adherence is to be maintained. This notwithstanding, rural patients were able to maintain HAART adherence for longer time interval between successive clinic visits. Furthermore, the findings indicated that optimal HAART adherence was low for some sub-populations, such as the urban and male populations, thus vigorous ongoing adherence counseling is required.

Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review

“…Lower levels of education corresponded with non-adherence, 42 45 52 53 56 57 and higher adherence was observed among patients with formal education. 58–60 However, some articles reported the opposite.…”

“…Other predictors reported to be associated with (non-)adherence were: distance to clinic, 29 37 41 52 84 85 111 121 having children, 88 93 106 110 114–116 122 geographical area, 45 58 96 117 123 marital status, 41 53 58 61 64 65 68 104 number of sexual partners, 47 124 travelling, 33 71 105 109 110 forgetting to take medication, 59 71 83 84 hospital versus government ART initiative, 51 living situation, 87 tobacco use, 47 unable to maintain healthy lifestyle 122 and language barriers. 36 …”

“…Non-adherence was associated with the following determinants: use of alcohol (OR=1.78; 95% CI 1.51 to 2.09; I 2 =39%), 23 46 61 64 66 72 74 76 86 87 binge drinking (OR=2.25; 95% CI 1.92 to 2.65; I 2 =18%), 31 42 46 47 65 70 73 75 86 male gender (OR=1.73; 95% CI 1.34 to 2.23; I 2 =60%), 22 31 42 47 48 51 61 younger age (15–35 years; OR=1.61; 95% CI 1.25 to 2.06; I 2 =92%), 30 32 34 35 37 39 40 61 low or no education (OR=1.80; 95% CI 1.09 to 2.98; I 2 =81%), 30 75 78 93 97 114 118 use of herbal/traditional medicine/treatment (OR=2.65; 95% CI 1.18 to 5.95; I 2 =78%), 90 91 95 96 98 low income or living below poverty level (OR=3.36; 95% CI 2.22 to 5.93; I 2 =66%), 28 42 47 52 96 104 costs forming barriers to treatment (OR=3.09; 95% CI 1.78 to 5.37; I 2 =59%), 40 59 62 111 117 urban treatment site or urban residence (OR=3.32; 95% CI 2.26 to 4.87; I 2 =0%) 45 58 96 and food insecurity (OR=1.95; 95% CI 1.65 to 2.29; I 2 =13%). 31 49 53 65 72 …”

Socio-Demographic, Economic and Clinical predictors of HAART Adherence Competence for HIV Positive adults at Felege Hiwot Teaching and Specialized Hospital, North West Ethiopia

“…Education had significant effect on the variable of interest in this study. More educated patients may easily understand the use of proper adherence [40] for progression of absolute difference in CD4 cells count as compared to non-educated patients. As visiting time /follow-up visits increased, the absolute difference in CD4 cells count also increased; and this result further leads to be HAART adherent [41].…”

Evidence of reduced treatment adherence among HIV infected paediatric and adolescent populations in Nairobi at the onset of the UNAIDS Universal Test and Treat Program

“…Previous studies have proved the direct link between poor adherence to ART and increased risk of treatment failure [ 15 – 17 ]. This is even more concerning in the light of UTT ART scale-up for the 22 million people who were not on ART before September 2016 [ 18 , 19 ]. Prior to UTT implementation, patients received thorough ART counselling before being initiated on treatment.…”