Abstract
BackgroundThe benefits of antiretroviral therapy (ART) cannot be experienced if they are not taken as prescribed. Yet, not all causes of non-adherence are dependent on the patient. Having to pay for medication reduces adherence rates. Non- adherence has severe public health implications which must be addressed locally and globally. This paper seeks to describe the trends in adherence rates reported in Cameroon and to investigate the determinants of adherence to ART in the Cameroon Mobile Phone SMS (CAMPS) trial.MethodsWe conducted a systematic review of electronic databases (PubMed, Google Scholar, Web of Science, CINAHL, EMBASE and PSYCINFO) for publications on adherence to ART in Cameroon (from January 1999 to May 2012) and described the trend in reported adherence rates and the factors associated with adherence. Data were extracted in duplicate. We used multivariable analyses on the baseline data for 200 participants in the CAMPS trial to determine the factors associated with adherence in four models using different measures of adherence (more than 90% or 95% on the visual analogue scale, no missed doses and a composite measure: 100% on the visual analogue scale, no missed doses and all pills taken on time).ResultsWe identified nine studies meeting our inclusion criteria. Adherence to ART in Cameroon has risen steadily between 2000 and 2010, corresponding to reductions in the cost of medication. The factors associated with adherence to ART in Cameroon are grouped into patient, medication and disease related factors. We also identified factors related to the health system and the patient-provider relationship. In the CAMPS trial, education, side effects experienced and number of reminder methods were found to improve adherence, but only using multiple reminder methods was associated with better adherence in all the regression models (Adjusted Odds Ratio [AOR] 4.11, 95% Confidence Interval [CI] 1.89, 8.93; p<0.001; model IV).ConclusionsReducing the cost of ART is an important aspect of ensuring adequate adherence rates. Using multiple reminder methods may have a cumulative effect on adherence to ART, but should be investigated further.
Highlights
The benefits of antiretroviral therapy (ART) cannot be experienced if they are not taken as prescribed
The factors associated with adherence to ART exist in many categories, defined in literature [1,16,19]: Patient factors such as substance abuse, being male, depression, lower levels of education, lack of self efficacy, extreme anxiety, extreme pain, no change in health status despite ART and non-white race are significantly associated with non-adherence [1,19]
The second, Mosoko et al [25], reported very low adherence rates (10.1% using hospital records of the number of scheduled clinic visits attended). These data may be affected by inaccuracies in hospital records; participants who lived far away were sometimes given medication for more than one month; patients who lived in the nearby city of Douala had other ART opportunities and this measure considers all deaths and lost to follow-up as non-adherent
Summary
The benefits of antiretroviral therapy (ART) cannot be experienced if they are not taken as prescribed. Antiretroviral therapy (ART) reduces viral loads to undetectable levels, and dramatically decreases morbidity and mortality. Decreasing serum viral load with antiretroviral medication reduces mother to child transmission rates [2,3]. Non-adherence to HIV medication is a major reason for treatment failure, the development of resistant strains, and increased costs [6]. It is one of the key predictors or determinants of success in the management of HIV/AIDS and the progression to AIDS and death [7,8]. Adherence to ART has clinical and public health implications, and should be addressed on global and local levels
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