Abstract
BackgroundThere are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru).MethodsThis was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann–Whitney test, Chi square test, and Yates correction.ResultsThe 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir + Lamivudine + Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence.ConclusionsSelf-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.
Highlights
At the end of 2017, there were approximately 2 million [1.5–2.3 million] people living with HIV (PLHIV) in Latin America [1, 2]
Men who have sex with men (MSM) and transgender women (TW) in Peru are disproportionately impacted by HIV [5], with a prevalence as high as 12.4% for MSM and 30% for TW compared to less than 0.23% for the general population [6, 7]
Almost half of the participants selfidentified as heterosexuals (49.4%; 89) and single (67.8%; 122) with no children (63.9%; 115), and (19.4%; 35), living with a partner, including about half of them living with a same sex partner (11.1%; 20)
Summary
At the end of 2017, there were approximately 2 million [1.5–2.3 million] people living with HIV (PLHIV) in Latin America [1, 2]. In Peru, there are approximately 72,000 [55,000–94,000] PLHIV; an estimated 16,250 of these people are unaware of their infection [3]. The majority of the HIV literature for these populations in Peru is based on international surveillance or small observational studies focused on the Lima Metropolitan region [7,8,9,10,11,12]. There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru)
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