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AIDS. 2007 Aug 20;21(13):1799-803.

Determinants of adherence to highly active antiretroviral therapy among HIV-1-infected patients in Côte d'Ivoire.

Author information

1
Unité de Soins Ambulatoires et de Conseils, Abidjan, Côte d'Ivoire, Canada.

Abstract

OBJECTIVE:

To assess adherence to HAART and to determine factors associated with poor adherence among HIV-1-infected patients in Abidjan, Côte d'Ivoire.

METHODS:

A prospective observational study of 614 consecutive patients attending an HIV/AIDS outpatient clinic. Adherence was measured twice at 3-month intervals by self-report of missing doses over 4 days. An adherence level of less than 95% was defined as poor adherence. We used generalized estimating equation models for binomial distribution with repeated measures for data analysis.

RESULTS:

Of the 591 subjects who completed the study, 74.3% reported adherence levels of 95% or greater. Six factors were independently related to poor adherence: age less than 35 years [relative risk (RR) 1.45; 95% confidence interval (CI) 1.17-1.79], absence of social support (RR 1.66; 95% CI 1.24-2.24), number of daily pills 10 or more (RR 1.47; 95% CI 1.14-1.91), time of adherence assessment (first versus second time assessment RR 1.36; 95% CI 1.12-1.66), CD4 cell count of 250 cells/mul or greater (RR 1.43; 95% CI 1.10-1.88), and not being less worried about HIV infection now that treatments have improved (RR 1.26; 95% CI 1.01-1.58). Drug supply interruptions in the pharmacies were reported by 10.0% of the non-adherent patients as the reason for missing pills.

CONCLUSION:

Psychosocial factors were found to impact adherence and should be analysed in more detail by further studies. Scaling up antiretroviral therapy in sub-Saharan Africa should be preceded by reliable drug supply and distribution systems.

PMID:
17690579
DOI:
10.1097/QAD.0b013e3282a5667b
[Indexed for MEDLINE]

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