Predictors of non adherence to antiretroviral therapy at an urban HIV care and treatment center in Tanzania

Sangeda, Raphael Z., Fausta Mosha, Aboud, Said, Kamuhabwa, Appolinary R., Chalamilla, Guerino E. Guerino E., Jurgen Vercauteren, Eric Van Wijngaerden, Lyamuya, Eligius Francis, AM Vandamme

Research output: Contribution to journalArticle

Abstract

Background: Measurement of adherence to antiretroviral therapy (ART) can serve as a proxy for virologic failure in resource-limited settings. The aim of this study was to determine the factors underlying nonadherence measured by three methods. Patients and methods: This is a prospective longitudinal cohort of 220 patients on ART at Amana Hospital in Dar es Salaam, Tanzania. We measured adherence using a structured questionnaire combining a visual analog scale (VAS) and Swiss HIV Cohort Study Adherence Questionnaire (SHCS-AQ), pharmacy refill, and appointment keeping during four periods over 1 year. Overall adherence was calculated as the mean adherence for all time points over the 1 year of follow-up. At each time point, adherence was defined as achieving a validated cutoff for adherence previously defined for each method. Results: The proportion of overall adherence was 86.4% by VAS, 69% by SHCS-AQ, 79.8% by appointment keeping, and 51.8% by pharmacy refill. Forgetfulness was the major reported reason for patients to skip their medications. In multivariate analysis, significant predictors to good adherence were older age, less alcohol consumption, more advanced World Health Organization clinical staging, and having a lower body mass index with odds ratio (CI): 3.11 (1.55–6.93), 0.24 (0.09–0.62), 1.78 (1.14–2.84), and 0.93 (0.88–0.98), respectively. Conclusion: We found relatively good adherence to ART in this setting. Barriers to adherence include young age and perception of well-being.
Original languageEnglish
Pages (from-to) 79-88
Number of pages10
JournalDrug, Healthcare and Patient Safety
VolumeVol. 10
DOIs
Publication statusPublished - 2018

Keywords

  • Adherence barriers
  • AIDS
  • Appointment keeping
  • Pharmacy refill
  • Resource-limited settings
  • Self-report

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