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J Acquir Immune Defic Syndr. 2008 Apr 15;47(5):615-22. doi: 10.1097/QAI.0b013e318165dc25.

Predictors of adherence to antiretroviral therapy in rural Zambia.

Author information

1
Institute of Global Health, Departments of Pediatrics and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN 37232-0242, USA. james.g.carlucci@vanderbilt.edu

Abstract

BACKGROUND/OBJECTIVE:

Antiretroviral therapy (ART) adherence levels of >or=95% optimize outcomes and minimize HIV drug resistance. As such, identifying barriers to adherence is essential. We sought to assess travel to point-of-care for ART as a potential barrier to adherence in rural Zambia, within the context of patient demographics, perceived stigma, and selected clinical indices.

METHODS:

We studied 424 patients receiving ART from the Macha Mission Hospital (MMH). Interviews ascertained age, gender, education, perceived stigma, nearest rural health facility (RHF), and mode/cost/time of transport for each study participant. Motorcycle odometer and global positioning system way-points measured distance from the MMH to each of the RHFs, estimating patients' home-to-MMH travel distances. Body mass index, World Health Organization HIV/AIDS stage, and pill counts were assessed from review of patients' medical and pharmacy records.

RESULTS:

At least 95% adherence was documented for 83.7% of the patients in their first months of ART. Travel-related factors did not predict adherence. Adherence was higher for those on ART for a longer time (odds ratio = 1.04 per day; P = 0.002).

CONCLUSIONS:

Patients in rural Zambia can achieve adherence rates compatible with good clinical outcomes despite long travel distances. The MMH was able to provide quality HIV/AIDS care by implementing programmatic features selecting for a highly adherent population in this resource-limited setting.

PMID:
18209678
PMCID:
PMC2743102
DOI:
10.1097/QAI.0b013e318165dc25
[Indexed for MEDLINE]
Free PMC Article

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