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Long-term adherence to antiretroviral treatment and program drop-out in a high-risk urban setting in sub-Saharan Africa: a prospective cohort study.

Unge C, Södergård B, Marrone G, Thorson A, Lukhwaro A, Carter J, Ilako F, Ekström AM - PLoS ONE (2010)

Bottom Line: Adherence to ART and drop-out from the ART program were independent outcomes.Additionally, one quarter of patients dropped out for more than 90 days after the last prescribed ART dose.Not having a treatment buddy was associated with increased risk for drop-out (hazard ratio 1.4, 95% CI = 1.0-1.9).

View Article: PubMed Central - PubMed

Affiliation: Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. christianunge@gmail.com

ABSTRACT

Background: Seventy percent of urban populations in sub-Saharan Africa live in slums. Sustaining HIV patients in these high-risk and highly mobile settings is a major future challenge. This study seeks to assess program retention and to find determinants for low adherence to antiretroviral treatment (ART) and drop-out from an established HIV/ART program in Kibera, Nairobi, one of Africa's largest informal urban settlements.

Methods and findings: A prospective open cohort study of 800 patients was performed at the African Medical Research Foundation (AMREF) clinic in the Kibera slum. Adherence to ART and drop-out from the ART program were independent outcomes. Two different adherence measures were used: (1) "dose adherence" (the proportion of a prescribed dose taken over the past 4 days) and (2) "adherence index" (based on three adherence questions covering dosing, timing and special instructions). Drop-out from the program was calculated based on clinic appointment dates and number of prescribed doses, and a patient was defined as being lost to follow-up if over 90 days had expired since the last prescribed dose. More than one third of patients were non-adherent when all three aspects of adherence--dosing, timing and special instructions--were taken into account. Multivariate logistic regression revealed that not disclosing HIV status, having a low level of education, living below the poverty limit (US$ 2/day) and not having a treatment buddy were significant predictors for non-adherence. Additionally, one quarter of patients dropped out for more than 90 days after the last prescribed ART dose. Not having a treatment buddy was associated with increased risk for drop-out (hazard ratio 1.4, 95% CI = 1.0-1.9).

Conclusion: These findings point to the dilemma of trying to sustain a growing number of people on life-long ART in conditions where prevailing stigma, poverty and food shortages threatens the long-term success of HIV treatment.

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Related in: MedlinePlus

Reasons for not taking ART during the last month at baseline and follow up.
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pone-0013613-g001: Reasons for not taking ART during the last month at baseline and follow up.

Mentions: When asked to report long-term adherence, 37% of the 352 patients said they had missed at least one of their ARV doses at some time between the past week and the last 3 months and as many as 15% had missed taking their ART the previous weekend (Appendix S1). The most common reasons stated for missing drugs over the past month were “simply forgot” (28%) and “ran out of pills” (19%). Other reasons for missing drugs at baseline and follow-up are summarized in Figure 1.


Long-term adherence to antiretroviral treatment and program drop-out in a high-risk urban setting in sub-Saharan Africa: a prospective cohort study.

Unge C, Södergård B, Marrone G, Thorson A, Lukhwaro A, Carter J, Ilako F, Ekström AM - PLoS ONE (2010)

Reasons for not taking ART during the last month at baseline and follow up.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2963610&req=5

pone-0013613-g001: Reasons for not taking ART during the last month at baseline and follow up.
Mentions: When asked to report long-term adherence, 37% of the 352 patients said they had missed at least one of their ARV doses at some time between the past week and the last 3 months and as many as 15% had missed taking their ART the previous weekend (Appendix S1). The most common reasons stated for missing drugs over the past month were “simply forgot” (28%) and “ran out of pills” (19%). Other reasons for missing drugs at baseline and follow-up are summarized in Figure 1.

Bottom Line: Adherence to ART and drop-out from the ART program were independent outcomes.Additionally, one quarter of patients dropped out for more than 90 days after the last prescribed ART dose.Not having a treatment buddy was associated with increased risk for drop-out (hazard ratio 1.4, 95% CI = 1.0-1.9).

View Article: PubMed Central - PubMed

Affiliation: Division of Global Health, IHCAR, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden. christianunge@gmail.com

ABSTRACT

Background: Seventy percent of urban populations in sub-Saharan Africa live in slums. Sustaining HIV patients in these high-risk and highly mobile settings is a major future challenge. This study seeks to assess program retention and to find determinants for low adherence to antiretroviral treatment (ART) and drop-out from an established HIV/ART program in Kibera, Nairobi, one of Africa's largest informal urban settlements.

Methods and findings: A prospective open cohort study of 800 patients was performed at the African Medical Research Foundation (AMREF) clinic in the Kibera slum. Adherence to ART and drop-out from the ART program were independent outcomes. Two different adherence measures were used: (1) "dose adherence" (the proportion of a prescribed dose taken over the past 4 days) and (2) "adherence index" (based on three adherence questions covering dosing, timing and special instructions). Drop-out from the program was calculated based on clinic appointment dates and number of prescribed doses, and a patient was defined as being lost to follow-up if over 90 days had expired since the last prescribed dose. More than one third of patients were non-adherent when all three aspects of adherence--dosing, timing and special instructions--were taken into account. Multivariate logistic regression revealed that not disclosing HIV status, having a low level of education, living below the poverty limit (US$ 2/day) and not having a treatment buddy were significant predictors for non-adherence. Additionally, one quarter of patients dropped out for more than 90 days after the last prescribed ART dose. Not having a treatment buddy was associated with increased risk for drop-out (hazard ratio 1.4, 95% CI = 1.0-1.9).

Conclusion: These findings point to the dilemma of trying to sustain a growing number of people on life-long ART in conditions where prevailing stigma, poverty and food shortages threatens the long-term success of HIV treatment.

Show MeSH
Related in: MedlinePlus