Abstract
BackgroundIn HIV-infected persons, good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes. Patients’ worries before starting ART may affect their ART adherence and treatment outcomes.MethodsBetween 2004 and 2009, HIV-infected individuals in a prospective cohort study in rural Uganda were assessed for ART eligibility. A counsellor explained the ART eligibility criteria, adherence and side effects, and recorded the patients’ worries related to ART. Every quarter, patients who initiated ART had clinical, immunological (CD4 cell counts) and virological (viral loads) assessments, and data were collected on ART adherence using patients’ self-reports and pill counts. We describe the patients’ worries and examine their association with ART adherence, and immunological and virological outcomes.ResultsWe assessed 421 patients, 271 (64%) were females, 318 (76%) were aged 30 years and above and 315 (75%) were eligible for ART. 277 (66%) reported any worry, and the proportions were similar by sex, age group and ART eligibility status. The baseline median CD4 counts and viral loads were similar among patients with any worry and those with no worry. The commonest worries were: fear of HIV serostatus disclosure; among 69 (16%) participants, lack of food when appetite improved after starting ART; 50 (12%), concurrent use of other medications; 33 (8%), adherence to ART; 28 (7%) and problems concerning condom use; 27 (6%). After 24 months or more on ART, patients who reported any worry had made more scheduled ART refill visits than patients who reported no worry (p<0.01), but the annual CD4 cell increases were similar (p=0.12). After one year on ART, patients who reported any worry had greater virological suppression than patients who reported no worry (p<0.05).ConclusionsDespite the lack of significant associations of worries with unfavourable ART outcomes, physicians and counsellors should assist patients in overcoming their worries that can cause stress and discomfort. Food supplements may be desirable for some patients initiating ART.
Highlights
In HIV-infected persons, good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes
There were no significant differences in the distribution of ART eligibility status, patients’ gender, median CD4 cell counts and median viral loads between individuals who had no worries and those who had one worry or more
Among the 225 patients who had completed 12 months on ART, there was no association between ART adherence and prior worries about ART (Table 3)
Summary
In HIV-infected persons, good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes. In HIV-infected persons, good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes and improved quality of life with reduced morbidity and mortality [1,2,3]. We describe the worries reported by adult patients at the first assessment for ART eligibility and examine the possible association of these worries with; ART adherence, and immunological and virological ART outcomes. This information will be useful in the counselling and assessment of patients for the lifelong ART
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