Abstract
ObjectiveThis study aims to investigate the time pattern of inconsistence condom use (ICU) during the first year of antiretroviral therapy (ART) and its relationship with treatment adherence in naïve HIV-infected adult patients.MethodsData collection was nested within a longitudinal trial on HIV treatment. ICU was defined as reporting to have “never”, “sometimes” or “nearly always” used condoms with one’s main or casual partner(s) - either HIV-negative or of unknown HIV status in the three previous months. Adherence was defined as taking 100% of their ART prescribed doses in the 4 days before the visit and “not having interrupted treatment”, even once, for more than two consecutive days during the 4 previous weeks. Mixed logistic regression was used to study the relationship between adherence and ICU.ResultsAmong the 459 patients enrolled, 212 (46%) during 334 visits reported to have had sexual intercourse at least once with their partner(s) – either HIV-negative or of unknown HIV status- during the first 12 months of ART. The proportion of ICU was 76%, 50% and 59% at month 0 (M0), month 6 (M6) and month 12 (M12), while 60% and 66% of patients were ART-adherent at M6 and M12, respectively. After adjustment for the frequency of sexual activity, type of sexual partner(s), perceived social class and desire for a child, patients adherent to ART were less likely to report ICU when compared with baseline (AOR [95% CI]: 0.38 [0.19–0.76]; P = 0.006).ConclusionsAdherence to ART is associated with a lower risk of ICU but this result needs to be interpreted carefully. As adherence behaviors are not only determined by problems with the healthcare systems but also by social barriers encountered by patients in their daily life, counseling should not only be ART adherence-centered but also patient-centered, including sexual risk minimization and psychosocial support.
Highlights
Since the introduction of the WHO ‘‘3 by 5’’ initiative [1], access to and use of health services providing antiretroviral therapy (ART) by people living with HIV/AIDS (PLWHA) in SubSaharan Africa has increased rapidly and substantially
While ART is increasingly regarded as a preventive intervention able to significantly reduce sexual transmission of HIV through decreased viremia [3,4], sexual behaviors among PLWHA on ART remain a topic of major interest in Sub-Saharan Africa where the great majority of infections are attributable to sexual transmission [5]
Several studies have confirmed that sustained adherence and continuity of ART - the basic conditions for treatment as prevention (TasP) [4] - remain a major challenge in Sub-Saharan countries where access to treatment is constrained by economic and structural barriers [6]
Summary
Since the introduction of the WHO ‘‘3 by 5’’ initiative [1], access to and use of health services providing antiretroviral therapy (ART) by people living with HIV/AIDS (PLWHA) in SubSaharan Africa has increased rapidly and substantially. This progress in ART coverage remains concomitant with a high incidence of HIV infection, highlighting the need for substantially greater success in the prevention of new HIV infections [2]. The relationship between ART adherence and unsafe sexual behaviors is of particular interest as the former may be considered a major component of the well-known ‘‘Swiss statement’’ which claims that there is a reduced likelihood of HIV sexual transmission in patients with a history of adherence and controlled viremia [4]
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