Adherence to antiretroviral therapy (ART) during the early months of treatment in rural Zambia: influence of demographic characteristics and social surroundings of patients

Yuri Sasaki,Kiyoshi Kita,Kenichi Komada,Gardner Syakantu,Shinsuke Miyano,Crispin Moyo,Naoko Ishikawa,Izukanji Sikazwe,Ichiro Kai,Kazuhiro Kakimoto,Christopher Dube

doi:10.1186/1476-0711-11-34

Abstract

BackgroundAround 70% of those living with HIV in need of treatment accessed antiretroviral therapy (ART) in Zambia by 2009. However, sustaining high levels of adherence to ART is a challenge. This study aimed to identify the predictive factors associated with ART adherence during the early months of treatment in rural Zambia.MethodsThis is a field based observational longitudinal study in Mumbwa district, which is located 150 km west of Lusaka, the capital of Zambia. Treatment naive patients aged over 15 years, who initiated treatment during September-November 2010, were enrolled. Patients were interviewed at the initiation and six weeks later. The treatment adherence was measured according to self-reporting by the patients. Multiple logistic regression analysis was performed to identify the predictive factors associated with the adherence.ResultsOf 157 patients, 59.9% were fully adherent to the treatment six weeks after starting ART. According to the multivariable analysis, full adherence was associated with being female [Adjusted Odds Ratio (AOR), 3.3; 95% Confidence interval (CI), 1.2-8.9], having a spouse who were also on ART (AOR, 4.4; 95% CI, 1.5-13.1), and experience of food insufficiency in the previous 30 days (AOR, 5.0; 95% CI, 1.8-13.8). Some of the most common reasons for missed doses were long distance to health facilities (n = 21, 53.8%), food insufficiency (n = 20, 51.3%), and being busy with other activities such as work (n = 15, 38.5%).ConclusionsThe treatment adherence continues to be a significant challenge in rural Zambia. Social supports from spouses and people on ART could facilitate their treatment adherence. This is likely to require attention by ART services in the future, focusing on different social influences on male and female in rural Zambia. In addition, poverty reduction strategies may help to reinforce adherence to ART and could mitigate the influence of HIV infection for poor patients and those who fall into poverty after starting ART.

Highlights

Around 70% of those living with HIV in need of treatment accessed antiretroviral therapy (ART) in Zambia by 2009
The treatment adherence continues to be a significant challenge in rural Zambia
Social supports from spouses and people on ART could facilitate their treatment adherence

Summary

Introduction

Around 70% of those living with HIV in need of treatment accessed antiretroviral therapy (ART) in Zambia by 2009. This study aimed to identify the predictive factors associated with ART adherence during the early months of treatment in rural Zambia. In 2009, the average number of people living with HIV (PLWH) reached 22.5 million [1,2,3]. Since Zambia’s first reported AIDS diagnosis in 1984, the proportion of PLWH has rapidly increased, The National HIV/AIDS/STD/TB Council (NAC) in Zambia became operational in 2002. One of its key priorities is the provision of care, treatment and support to PLWH [3]. The government declared that the entire ART service package would be provided free of charge in the public sector, with a goal of universal access to HIV care and treatment [8]

Objectives

Methods

Results

Conclusion