Level Of Antiretroviral Therapy Adherence Research Articles

Level of antiretroviral therapy adherence and associated factors during COVID-19 pandemic era in public hospitals of Jigjiga City eastern Ethiopia: a cross-sectional study

BackgroundCoronavirus-19 disease is more severe in patients on antiretroviral therapy (ART). Low-income countries, such as those in Sub-Saharan Africa, are particularly vulnerable to the virus’ spread. However, there is little information on antiretroviral therapy (ART) use in Ethiopia during the pandemic, particularly in the study area. Therefore, this study aimed to assess the level of antiretroviral treatment adherence and associated factors during the COVID-19 pandemic era in public hospitals in Jigjiga City, Somalia, and Eastern Ethiopia.MethodsAn institution-based cross-sectional study was conducted among 382 randomly selected HIV patients on antiretroviral therapy (ART) follow-up in public hospitals in Jigjiga City from March 1–30, 2022. The data was collected through face-to-face interviews and a review of the patient’s record. To explore the relationship between variables, both bivariate and multivariable logistic regression analyses were performed. The adjusted odds ratio (AOR) was utilized, along with a 95% confidence interval, to assess the strength and direction of the association. Statistical significance was considered at p < 0.05.ResultsThe antiretroviral therapy (ART) adherence rate of HIV patients was 76.9% (95% CI, 71.9–82). Disclosing HIV status to sexual partners [AOR = 2.3, (95% CI (1.22–4.19)], having communication with health care providers’ [AOR = 3.2, (95% CI (1.57–6.53)], having no history of current substance use [AOR = 2.6, (95% CI (1.45–4.63)], and patients who did not fear COVID-19 infection [AOR = 5.8 (95% CI (11–10.98)] were significantly associated with antiretroviral therapy (ART) adherence.ConclusionIn this study, the level of antiretroviral therapy (ART) adherence was poor in comparison to the expected level. Patients’ adherence status was favorably related to disclosing their status to families and having contact with their healthcare providers, whereas worrying about COVID-19 pandemic infection and current substance use was adversely associated.

The level of antiretroviral therapy (ART) adherence among orphan children and adolescents living with HIV/AIDS: A systematic review and meta-analysis.

Many children and adolescents living with HIV have ended up as orphans. Due to HIV taking away their parents leaves them deprived of their most important social network and support, which predisposes them to poor adherence to antiretroviral therapy (ART). Various studies have shown poor adherence to ART among orphaned children and adolescents. This systematic review and meta-analysis, therefore, aims to determine the level of ART adherence among orphaned children and adolescents living with HIV/AIDS. This PROSPERO registered review (CRD42022352867) included studies from PubMed, Google Scholar, Scopus, Web of Science, Africa Journal Online, and selected HIV/AIDS journals from data inception to June 01, 2022. We included articles published in all languages that report the prevalence of adherence to ART among children and adolescent orphans (single parent orphans and/or double orphans) living with HIV/AIDS. We excluded qualitative studies, case studies, opinion papers, and letters to editors. We used the random-effect model to calculate the pooled prevalence of ART adherence based on the highest prevalence provided by the various methods in a particular study. We used the Joanna Briggs Institute Appraisal tool for the prevalence study to evaluate for risk of bias in the included studies. The Egger's test was used to assess small study effects. Out of 1087 publications identified from the various databases, six met the selection criteria. The included six studies had a total 2013 orphans living with HIV/AIDS. The pooled prevalence of ART adherence was 78∙0% (95% Confidence Interval: 67.4-87.7; I2 = 82.92%, p<0∙001) and ranged between 7∙6% and >95%, using one of the following methods: pill count, caregiver's self-report, clinical attendance, and nevirapine plasma levels (above three μg/mL). The factors associated with adherence were pill burden, caregiver involvement, stunting, and caregiver relationship. There was a high level of heterogeneity in the finding. Approximately four fifth of orphan children and adolescents living with HIV/AIDS adhere to ART. Strategies to improve adherence among this group should be prioritized, especially among the double orphaned children and adolescents.

Level Of ART Adherence and associated factors among People Living with HIV in the Context of Early Antiretroviral therapy initiation In Wolaita Sodo Town, Ethiopia: Cross-sectional study.

Early antiretroviral therapy initiation is WHO recommendation for fasten viral suppression and for prevention of further viral transmission sexually. There is no evidence showing the level of adherence to antiretroviral therapy (ART) after initiation of the universal test and treat (UTT) strategy in Ethiopia, including study area. This study was aimed to determine the level of ART adherence and associated factors among HIV/AIDS patients in context of Universal test and treat strategy. A Health facility-based study was conducted on 352 people living with HIV who started their ART follow-up after application of universal test and treat strategy in Ethiopia from 15 April to 5 June 2020. Systematic random sampling method was used to select the study participants. Interviewer administered questionnaire was used to collect data and collected data were entered directly in to SPSS version 21 and analyzed. Both bivariate and multivariate logistic regression analyses were done. Strength and direction of association was determined by using AOR with 95%CI. The total 352 participants included the study. The overall level of adherence was 290 (82.4%). Commonly used ART regimen was TDF+3TC+EFV, 201(57.1%). In bivariate analysis, type of health institutions COR 2.934(1.388, 6.200), age level of 18-27 COR .357(.133, .959), current viral load in log scale COR= .357(.133, .959) and change of ART medication COR= 8.088(1.973, 33.165) were associated with medication adherence. Health institution type AOR = 2.615(1.147, 5.9600) and change of ART medication AOR= 7.267 (1.683, 31.384) were independent predictors of ART adherence. Low level of ART adherence was detected in this study. It was below the recommended good adherence standard and 90-90-90 target strategy. Therefore, patients should get adequate and comprehensive ART adherence counseling before initiation ART treatment and during the follow-up time.

Adherence to Antiretroviral Therapy and Associated Factors Among HIV-Infected Children in Public Health Institutions of Adwa, Axum, and Shire Towns of Tigray, Northern Ethiopia: A Cross-Sectional Study.

Antiretroviral therapy (ART) provision was among the major challenge of treatments. Maintaining the optimal level of adherence among children living with HIV/AIDS is a pivotal step towards achieving treatment success. However, there are limited studies on child's ART adherence. Therefore, this study aimed to assess the level of adherence to antiretroviral therapy and associated factors among HIV-infected children in health institutions of Adwa, Axum, and Shire towns, Tigray, Northern Ethiopia. An institutional-based cross-sectional study was conducted among human immunodeficiency virus (HIV)-infected children in between February and April, 2016. A total of 255 children who were taking antiretroviral therapy in the randomly selected three health facilities from Adwa, Axum and Shire towns were included. Data were collected using pretested and structured questionnaires using a face-to-face interview. The collected data were entered into Epi Info version 7 and then exported to SPSS version 21 for analysis. Bivariate and multivariate binary logistic regression models were used to determine the factors associated with adherence to antiretroviral therapy among HIV-infected children. A total of the 255 study participants were included in the study. The level of ART adherence among HIV-positive children was 212 (84.8%). Knowledge of caregivers about ART treatment (AOR = 2.78, 95% CI: 1.18, 6.53), occupational status (AOR = 4.78, 95% CI: 1.26, 18.91), appointment to ART less than two months (AOR = 3.05, 95% CI: 1.21, 7.70) and use of memory aids (AOR = 4.58, 95% CI: 1.73, 12.13) were independently associated with adherence to ART. The level of adherence to antiretroviral therapy was low. Healthcare providers should reinforce adherence intervention and counseling sessions during follow-up and address the proper use of medication reminders to help children take their drugs appropriately.

The Moderating Role of Social Support and HIV Stigma on the Association Between Depression and ART Adherence Among Young Thai Men Who Have Sex with Men.

In Thailand, antiretroviral therapy (ART) programs still have difficulties reaching and promoting adherence among a key population - young men who have sex with men (YMSM) living with HIV. As such, we sought to examine potential psychosocial barriers that may contribute to suboptimal levels of ART adherence for this population. Data were drawn from a study of 214 YMSM living with HIV from Bangkok, Thailand. Linear regression models tested the association between depression and ART adherence, and whether social support and HIV-related stigma moderated that relationship. Multivariable models demonstrated social support was significantly associated with higher levels of ART adherence, and that there was a three-way interaction between depression, social support, and HIV-related stigma on ART adherence. These results further our understanding of the role of depression, stigma, and social support in ART adherence among Thai YMSM living with HIV, and that additional supports for YMSM with depression and HIV-related stigma are needed.

Association between recent methamphetamine use, antiretroviral therapy and HIV viral load; a mediation analysis from a cohort of HIV positive persons who inject drugs in Hai Phong, Vietnam.

There has been a significant increase in methamphetamine use among persons who use drugs in Vietnam in the last 5-10years. We examined the degree to which adherence to antiretroviral therapy (ART) mediates the relationship between recent methamphetamine use and unsuppressed HIV viral load among people who inject drugs (PWID) in Hai Phong, Vietnam. We recruited PWID from October 2016-October 2018 and enrolled HIV positive PWID into a cohort, with up to three years of total follow-up. We assessed relationships among recent methamphetamine use frequency, ART adherence and unsuppressed HIV viral load. Mediation analysis was used to estimate the total and natural direct effects of recent methamphetamine use on unsuppressed HIV viral load and the indirect effect proportion. We enrolled 792 HIV seropositive PWID into the cohort; approximately 75.9% reported high/perfect ART adherence at baseline and 81.3% were virally suppressed. In mediation analysis, the total effect for the association between methamphetamine use and unsuppressed HIV viral load (1000 copies/mL) was 3.94 (95% CI: 1.95, 7.96); the natural direct effect was 2.14 (95% CI: 1.29, 3.55); the proportion mediated by self-reported ART adherence was 0.444. Similar results were found when examining lower unsuppressed HIV viral load cutpoints of 250copies/mL and 500copies/mL. Methamphetamine use is associated with unsuppressed HIV viral load among PWID despite high levels of ART adherence. Further research is needed to better understand these relationships, with emphasis on potential biological pathways that may interact with ART.

The co-occurrence of the SAVA syndemic, depression and anxiety as barriers to antiretroviral therapy adherence among sub-Saharan Africa population groups: A scoping review protocol.

IntroductionThe scale-up of access to antiretroviral therapy has transformed HIV from an acute, terminal disease to a manageable chronic illness. Yet, sustaining high levels of antiretroviral therapy adherence remain a challenge, especially in the sub-Saharan Africa region which is disproportionately affected by HIV. This protocol proposes a scoping review to explore literature reporting on the antiretroviral therapy adherence levels among people who experience substance abuse and violence (SAVA) syndemics, as well as mood disorders such as anxiety and depression among people living with HIV in sub-Saharan Africa.Methods and analysisThis proposed scoping review will follow Arksey and O’Malley’s methodological framework for conducting scoping reviews as refined by Levac et al. The review will follow the Joanna Briggs Institute’s manual for conducting scoping reviews. Literature searches will be conducted using six databases: Academic search complete; APA PsycArticles; CINAHL; MEDLINE; SocINDEX and Web of science. Title screening will see the “Participant, Concept, Context” framework applied to identify relevant literature and will not include the appraisal of search results. Data charting will follow an adapted version of Trico and colleagues’ PRISMA-ScR and results will be mapped descriptively and in tabular format. Furthermore, results will be discussed within the syndemics model of health, and summarised as a biosocial conceptual model.Ethics and disseminationThe study will make use of secondary data that are readily available to the public and will not require ethical approval. We intend to publish our results in a peer-reviewed journal and disseminate our findings at relevant conferences and seminars.

Adherence to Antiretroviral Therapy by Pregnant Women Accessing Antenatal Clinic at The University of Port Harcourt Teaching Hospital, Tertiary Institution in Rivers State

Background: Non-adherence to antiretroviral therapy (ART) by pregnant women living with HIV/AIDS is a problem that has been reported to have adverse effects on the mother and the unborn child and this is a major public health issue in high- and low-income nations. Virological and clinical success depends critically on elevated adherence to ART, without which maternal disease can develop, with its attendant increase in the risk of vertical mother-to-child transmission. The level of non-adherence to ART is high in many communities in Nigeria. This study assesses the level of ART adherence and identifies factors that influence nonadherence among pregnant women living with HIV/AIDS.

Estimating the minimum antiretroviral adherence required for plasma HIV-1 RNA viral load suppression among people living with HIV who use unregulated drugs.

Owing to advances in antiretroviral therapy (ART), we re-examined minimum ART adherence levels necessary to achieve sustained HIV-1 viral load (VL) suppression among people with HIV who use drugs (PHIV-PWUD). We used data from ACCESS, a community-recruited prospective cohort of PHIV-PWUD in Vancouver, Canada. We calculated adherence using the proportion of days of ART dispensed in the year before each VL measurement. We used generalized linear mixed-effects models to identify adherence- and ART regimen-related correlates of VL suppression (<200 copies/ml). We employed probit regression models and generated dose-response curves to estimate the minimum adherence level needed to produce VL suppression in 90% of measures, stratified by regimen and calendar-year. Among 837 ART-exposed PHIV-PWUD recruited between 1996 and 2017, the overall estimated adherence level necessary to achieve 90% VL suppression was 93% (95% confidence interval [CI]: 90-96). This differed by regimen: 69% (95% CI: 45-92) for integrase inhibitor (INSTI)-, 96% (95% CI: 92-100) for boosted protease inhibitor (bPI)-, and 98% (95% CI: 91-100) for non-nucleoside reverse transcriptase inhibitor-based regimens. In multivariable analysis, INSTI-based regimens were positively associated with VL suppression (vs. bPIs), while un-boosted PIs and other regimens were negatively associated. We observed a decreasing temporal trend of estimated adherence necessary for 90% VL suppression, dropping to 64% (95% CI: 50-77) during 2016-2017. Although high levels of ART adherence were necessary to achieve consistent VL suppression, the minimum necessary adherence levels decreased over time. Overall, INSTI-based regimens performed the best, suggesting that they should be preferentially prescribed to PHIV-PWUD.

Adherence to HIV Antiretroviral Therapy Among Pregnant and Breastfeeding Women, Non-Pregnant Women, and Men in Burkina Faso: Nationwide Analysis 2019-2020.

BackgroundSince the scale-up of antiretroviral therapy (ART) services in Burkina-Faso, achieving an AIDS-free generation depends on optimal ART adherence. However, no data exists on the population group differences on the level of ART adherence in Burkina-Faso. This study analyzes ART adherence among pregnant-and breastfeeding-women, non-pregnant women, and men in Burkina-Faso.MethodsFrom December 2019 to March 2020, a cross-sectional study among adult HIV-infected patients in Burkina-Faso, belonging either to the active file or the Prevention of Mother-To-Child Transmission programs was conducted. An analysis was performed and adherence was measured based on the number of times, patients did not meet the number of doses prescribed and did not take the ART treatment in the month prior to the survey. Logistic-regression models were used to identify factors associated with poor ART adherence and the adjusted odds ratios (aORs) with their 95% confidence intervals (95% CI) were reported.ResultsThe prevalence of good adherence was higher in the group of pregnant-and breastfeeding-women (86.6%, n = 112) compared to the other groups (73.1%, n=1017 in non-pregnant women and 72.0%, n = 318 in men). No association was found between ART adherence and the socio-demographic, clinical, and therapeutic characteristics of pregnant-and breastfeeding-women and men groups. However, non-pregnant women with a high level of education (aOR = 1.70; 95% CI: 1.16–2.49), having ever belonged to a support group (aOR= 1.47; 95% CI: 1.07–2.04), not having income-generating occupations (aOR= 1.53; 95% CI: 1.11–2.12), and in advanced clinical stage (aOR= 1.42; 95% CI: 1.06–1.91) were more susceptible to have poor adherence compared to their pairs.ConclusionFindings showed a large difference in ART adherence among pregnant-and breastfeeding-women, non-pregnant women and men and highlight the need for differentiated healthcare delivery according to population while specifically considering addressing the interest in early initiation of treatment and the benefit of support groups meeting.

Non-adherence to Antiretroviral Treatment Episodes and Contributing Factors among Fully Disclosed Adolescents with Perinatal HIV in the Kingdom of Lesotho

Children and adolescents with Perinatal Acquired HIV (PHIV) face many challenges to remain adherent to long-term Antiretroviral Therapy (ART). Among adolescents, adherence is often not static but changes over time due to the circumstances of the individual. The study assessed the ART adherence levels and patterns of adolescents with PHIV who were receiving long-term ART. This quantitative cross-sectional study was conducted in Mohale's Hoek, a rural Health District in Lesotho between May and December 2018. Adolescents aged 10-19 years who were aware of their HIV status were recruited from selected youth-friendly HIV clinics. Adherence was measured through a self-report of the last pills missed, based on 30 days recall. Stata version 13 was used for analysis. The sample consisted of 130 adolescents, 57% were females, the mean age was 15 years, the mean age of ART initiation was nine years, and the mean ART duration was four years. Self-reported adherence was very high at 92%, and 88% reported not delaying taking ART. Self-reported optimal ART adherence was achieved by 85% of the adolescents, 15% were non-adherent, and 92.3% had not missed clinic appointments in the past 30 days. Episodes of non-adherence among those who delayed taking ART on time occurred in the evenings, mornings, weekdays, and weekends. Non-adherence episodes for 59% occurred more in the evenings than other periods of the day. Conclusion: The results suggest that despite high self-reported adherence, adolescents take medication inconsistently and have situational adherence patterns. The dosing of medication and regimens should be flexible and take into consideration the context of the adolescents.

Predictors of intestinal parasite infection among HIV patients on antiretroviral therapy in Jos, Plateau State, Nigeria, 2016: a cross-sectional survey.

Introductionintestinal parasitic infection has been reported as a cause of morbidity and mortality among HIV patients on antiretroviral therapy (ART) due to interruption in treatment of the defaulting HIV patients. This study aimed to determine the prevalence and possible causes of intestinal parasites among HIV patients on ART.Methodsa survey involving 375 adult HIV/AIDS patients selected using a systematic random sampling technique was conducted in a Jos University Teaching hospital, Plateau State, Nigeria. Socio-demographic and clinical data was collected using semi-structured interviewer administered questionnaire and electronic dataset review. Fresh stool samples were collected from all participants for laboratory identification of intestinal parasites using formol-ether sedimentation and modified Ziehl-Neelsen techniques. Descriptive statistics, odds ratio and logistic regression model were computed at P ≤ 0.05.Resultsthe mean age of the study participants was 41.6±9.3years. Majority 294 (78.4%) were females, 141 (37.6%) lived in the rural area, 50 (13.3%) respondents did not have toilets in their homes. Most 275 (73.3%) had ART adherence level of 95% and above. Prevalence of intestinal parasites was 28.5%. Females (aOR = 2.14, 95% CI=1.12 – 3.89) and participants with no toilet facilities (aOR = 2.0, 95% CI=1.03 – 3.94) were significantly more likely to have intestinal parasites.Conclusionthe prevalence of intestinal parasites was high among HIV patients. Gender and unavailability of toilet in homes were found to be predictors of having parasites. We recommend that HIV patients should be periodically screened for IPs during the follow-up clinic visits.

The level and potential determinants of the adherence to the antiretroviral therapy among patients on HIV treatment in gemena referral hospital, South Ubangi, Democratic Republic of Congo, 2018

Introduction: Suboptimal adherence to antiretroviral therapy (ART) is a major hinderance to achieving the 90 90 90 goals in limited resources settings. South Ubangi province in DR Congo faces countless challenges providing universal HIV care. However, the level of ART adherence and associated factors among people on HIV treatment in this province remains unknown. Using a quantitative method approach, this study aimed to know the extend of adherence and to identify the determinants of optimal and suboptimal adherence among study participants. Methods: A cross-sectional research design was used to survey patients on ART in Gemena Referral Hospital. Results: After a simple randomly sampling from a sampling frame of 503 patients on treatment and who met the inclusion criteria of been using HIV treatment for at least one year, 438 were selected taking the even numbers in three rounds, but only 398 patients consented to participate to the study. Logistic regression was run to explore determinants of the adherence. The participants’ mean age was 42 years old (range: 8-62 years old). 280 participants were Female (=70.4%) and 118 were male (29.6%) with a sex ratio Female-male of 2.4/1. Most of the participants were married 185(46.5%), 45 were divorced (=1.3%), 136 widow/widowers (34.2% made up of 116 widowers=29% and 20 widows=4.2%) and only 32 were unmarried (8%). Among the married, 117 had only one partner (29% of overall), 42 had more than one partner (11%) and 26 were in a mere cohabitation (6.5%). ART adherence was 77% in the study population, while it should reach the optimal level of 95%. Adherence was positively associated with age, but suboptimal adherence was significantly associated with forget to take the drugs, distance, the degree of contentment to the family support, and moving out of home. Adherence was likely associated with age, in fact, old participants(44-60 age group) had 8.3 times an increased probability of being adherent( 2.30-8.84, 95% CI, p-value=0.001) compared to 8-25 age group. Additionally, taking his pills on daily basis had 1.68 times an increased probability of optimal adherence (1.39-1.98, 95% CI, p-value&lt;0.001), compared to those patients who sometimes forget to take their pills. Distance &lt; or = 5 km also had 2.47 an increased probability of being adherent (2.06-2.87, p-value&lt;0.001) compared to people who live beyond 5 km from the health facility. Participants who stated they had a high degree of contentment to family support presented 1.93 times an increased probability of being adherent (1.93-1.46, 95% CI, p-value=0.001) compared with those with low degree of contentment to the family support. Participants who were resident had 1.55 times an increased significant probability to be adherent (1.28-1.82, 95% CI, p-value&lt;0.001), compared to those who temporarily/definitely moved out their home for any reason. Gender, marital status, and monthly income did not have a significant association with adherence to antiretroviral therapy among people surveyed in the study. Conclusion: Suboptimal adherence is still a serious issue among ARVs users in resource limited settings. Further strategies to boost adherence to the optimal level and beyond would imply to increase personal capacities to adhere to therapy instructions, lessen stigma and discrimination barriers by the proxy and within patients’ families and foster the implication of the family members and the community in therapy, promote drugs provisions at home and differentiated health care management, etc.

Expanded access to viral load testing and use of second line regimens in Haiti: time trends from 2010\u20132017

BackgroundHaiti initiated the scale-up of HIV viral load (VL) testing in 2015–2016, with plans to achieve 100% coverage for all patients on antiretroviral therapy (ART) for treatment of HIV/AIDS. In the absence of HIV drug susceptibility testing, VL testing is a key tool for monitoring response to ART and optimizing treatment results. This study describes trends in expanded use of VL testing, VL results, and use of second-line ART regimens, and explores the association between VL testing and second-line regimen switching in Haiti from 2010 to 2017.MethodsWe conducted a retrospective cohort study with 66,042 patients drawn from 88 of Haiti’s 160 national ART clinics. Longitudinal data from the iSanté electronic data system was used to analyze the trends of interest. We described patients’ VL testing status in five categories based on up to two most recent VL test results: no test; suppressed; unsuppressed followed by no test; re-suppressed; and confirmed failure. Among those with confirmed failure, we described ART adherence level. Finally, we used Cox proportional hazards regression to estimate the risk of second-line regimen switching by VL testing status, after adjusting for other individual characteristics.ResultsThe number of patients who had tests done increased annually from 11 in 2010 to 18,828 in the first 9 months of 2017, while the number of second-line regimen switches rose from 21 to 279 during this same period. Compared with patients with no VL test, the hazard ratio (HR) for switching to a second-line regimen was 22.2 for patients with confirmed VL failure (95% confidence interval [CI] for HR: 18.8–26.3; p < 0.005) after adjustment for individual characteristics. Among patients with confirmed VL failure, 44.7% had strong adherence, and fewer than 20% of patients switched to a second-line regimen within 365 days of VL failure.ConclusionsHaiti has significantly expanded access to VL testing since 2016. In order to promote optimal patient health outcomes, it is essential for Haiti to continue broadening access to confirmatory VL testing, to expand evidence-based initiatives to promote strong ART adherence, and to embrace timely switching for patients with confirmed ART failure despite strong ART adherence.

HIV virological non-suppression and factors associated with non-suppression among adolescents and adults on antiretroviral therapy in northern Ethiopia: a retrospective study

BackgroundDespite the benefits of Antiretroviral Therapy (ART), there is a growing concern of treatment failure. This study aimed to assess viral non suppression rate and factors associated with HIV viral non suppression among adolescents and adults on ART in Northern Ethiopia.MethodsA retrospective cross sectional study was done on 19,525 study subjects. All the data in the database of Tigray Health Research Institute was exported to Microsoft excel 2010 and then data verification and filtration were done before exporting to STATA 14.0 for analysis. Generalized Estimating Equation (GEE) logistic regression was used for statistical modeling of viral non suppression.ResultsA total of 5153 (26.39%; 95%CI (25.77%, 27.02)) patients had no viral suppression despite being on ART. Being male (AOR = 1.27, 95% CI: 1.18, 1.37), 15–19 years of age (AOR = 4.86, 95%CI: 3.86, 6.12), patients from primary hospital (AOR = 1.26, 95%CI: 1.05, 1.52), WHO staging II (AOR = 1.31, 95%CI: 1.10, 1.54), poor ART adherence level (AOR = 2.56, 95%CI: 1.97, 3.33), fair ART adherence level (AOR = 1.61, 95%CI: 1.36, 1.90), baseline CD-4 count of < 200 cells/micro liter (AOR = 1.33, 95%CI: 1.14, 1.54), recent CD-4 count of < 200 cells/micro liter (AOR = 3.78, 95%CI: 3.34, 4.27), regimen types: 1c (AZT-3TC-NVP) (AOR = 1.32, 95%CI: 1.22, 1.44), 2 h (TDF-3TC-ATV/R) (AOR = 1.79, 95%CI: 1.27, 2.52) and declined immunological responses after ART initiation (AOR = 1.45, 95%CI: 1.30, 1.61) were significantly associated with viral non-suppression.ConclusionsThe virological non suppression was high which makes it less likely to achieve the third 90 UNAIDS target. Being male, patients with WHO staging II and poor ART adherence level were significantly associated with viral non suppression. Therefore, intensive adherence support and counseling should be provided. It is also a high time to determine the antiretroviral drugs resistance pattern given the fact that a large number of patients had virological non suppression.

Antiretroviral Adherence Level Necessary for HIV Viral Suppression Using Real-World Data.

A benchmark of near-perfect adherence (≥95%) to antiretroviral therapy (ART) is often cited as necessary for HIV viral suppression. However, given newer, more effective ART medications, the threshold for viral suppression may be lower. We estimated the minimum ART adherence level necessary to achieve viral suppression. The Patient-centered HIV Care Model demonstration project. Adherence to ART was calculated using the proportion of days covered measure for the 365-day period before each viral load test result, and grouped into 5 categories (<50%, 50% to <80%, 80% to <85%, 85% to <90%, and ≥90%). Binomial regression analyses were conducted to determine factors associated with viral suppression (HIV RNA <200 copies/mL); demographics, proportion of days covered category, and ART regimen type were explanatory variables. Generalized estimating equations with an exchangeable working correlation matrix accounted for correlation within subjects. In addition, probit regression models were used to estimate adherence levels required to achieve viral suppression in 90% of HIV viral load tests. The adjusted odds of viral suppression did not differ between persons with an adherence level of 80% to <85% or 85% to <90% and those with an adherence level of ≥90%. In addition, the overall estimated adherence level necessary to achieve viral suppression in 90% of viral load tests was 82% and varied by regimen type; integrase inhibitor- and nonnucleoside reverse transcriptase inhibitor-based regimens achieved 90% viral suppression with adherence levels of 75% and 78%, respectively. The ART adherence level necessary to reach HIV viral suppression may be lower than previously thought and may be regimen-dependent.

Depression and Coping Are Associated with Failure of Adherence to Antiretroviral Therapy Among People Living with HIV/AIDS.

Sustained adherence to antiretroviral therapy (ART) is critical in the prevention of drug resistance, disease progression, and death. We aimed to assess the level of ART adherence among 112 people living with HIV/AIDS (PLWHA) and to determine associated factors with that. The socioeconomic aspects were evaluated by medical records; the adherence, depression, and coping by specific questionnaires. Although most patients have undetectable viral load (79%) and CD4+ T count >500 cells/mm3 (65%), two-third (66%) of them exhibited a lower adherence, which was directly associated with some signs of depression (p = .006) presented by 65% of them. Some risk factors to presence of depression were female gender (p = .008) and low income (p = .013). In addition, most participants who reported tobacco (33%) and alcohol (29%) consumption had a low or intermediate adherence score. Among the coping strategies, self-control (p = .029), social support (p = .006), problem solving (p = .013), and positive reappraisal (p = .049) led to an improvement in adherence.

Problem-Based Learning Could Tackle the Issue of Insufficient Education and Adherence in People Living With HIV/AIDS.

Background: Poor medication adherence is still the main cause of antiretroviral therapy (ART) failure among people living with HIV/AIDS (PLWHA). Effective behavioral interventions are needed to improve HIV awareness and medication adherence. Methods: In this retrospective cohort study, we assessed the effect of problem-based learning (PBL) approaches to HIV-related education and adherence outcomes among PLWHA and a college student sample. In our study, compared with 309 demography-matched control participants using conventional counseling methods (109 PLWHA and 200 college students), 321 subjects (111 PLWHA and 210 college students) chose to learn HIV-related knowledge via PBL-integrated methods. Co-primary outcomes were self-administered questionnaire after HIV-related education by all participants and self-reported medication adherence by newly diagnosed PLWHA, measured in terms of the number of missed doses in the past week at each of the seven visits during a 1-year period. Multivariate regression models adjusting different covariates were used to test the robustness of HIV awareness and adherence association. Mediation model was used to investigate the relationship among PBL training, awareness of HIV, and ART adherence. Results: The knowledge scores of participants in the PBL group were higher than those in the controls (P = 0.001), especially the subgroup of newly diagnosed PLWHA in the PBL group (P = 0.001). The HIV-related health scores of the PBL college students were also higher than those of subjects exposed to conventional education (P < 0.001). There was no significant difference between the two by newly diagnosed PLWHA groups in the number of missed doses during the past week at each visit except at the first follow-up visit (P = 0.018). The indirect effect of PBL-integrated education on ART adherence at the 2-week visit through HIV awareness had a point estimate of 0.0349 and a 95% bias-corrected bootstrap confidence interval of 0.0061∼0.0874 in newly diagnosed PLWHA. Conclusions: PLWHA and college students using PBL showed improved awareness of HIV and higher levels of recent ART adherence; however, there was no change in long-term ART adherence in newly diagnosed PLWHA.

Substance Use Stigma and Antiretroviral Therapy Adherence Among a Drug-Using Population Living with HIV.

Among people living with HIV (PLWH), HIV-related stigma predicts nonadherence to antiretroviral therapy (ART); however, the role of stigma associated with drug use is largely unknown. We examined the association between substance use (SU) stigma and optimal ART adherence in a sample of 172 self-reported HIV-infected drug users. Participants completed surveys on SU, stigma, and ART adherence. The three substance classes with the greatest number of participants exhibiting moderate/high-risk scores were for cocaine/crack cocaine (66.28%), cannabis (64.53%), and hazardous alcohol consumption (65.70%). Multivariable logistic regression was conducted to investigate associations between levels of SU stigma and optimal ART adherence, adjusting for sociodemographic characteristics, severity of illicit drug use (alcohol, smoking and substance involvement screening test) and alcohol use severity (Alcohol Use Disorders Identification Test-C), HIV-related stigma, and social support. The odds of optimal adherence among participants experiencing moderate [Adjusted Odds Ratio (AOR) = 0.36, p = 0.039] and very high (AOR = 0.25, p = 0.010) levels of anticipated SU stigma were significantly lower than participants experiencing low levels of anticipated SU stigma. No other stigma subscales were significant predictors of ART adherence. Interventions aiming to improve ART adherence among drug-using PLWH need to address anticipated SU stigma.

Antiretroviral Therapy Adherence Level and Associated Factors Among HIV/AIDS Patients in Jimma Zone Government Health Facilities, ART Clinics, South-west Ethiopia

Optimal and strict adherence to Antiretroviral Viral Therapy a need for over the long period to achieve the goals of ART and obtain maximum benefits of ART. However, PLWHA find it very difficult to take ARVs drug as precisely as they should for a number of reasons. Therefore, this study aimed at examining the level of antiretroviral therapy adherence and identifying possible associated factors for ART adherence behavior in Jimma zone government ART facilities. A facility based cross-sectional study was conducted in the ART clinics of Jimma zone governmental health facilities in which ARV treatment supplied from November 25/2015 – February 30/2016 for a period of 4 months. 352 adult PLWHA (190 female and 162 male) ranged in age from 15-62 years (Mean=37.1, SD= 8.95), with 100% response rate, were our study participants. Binary logistic regression was used to perform bivariate and multivariate analyses to determine the association between study variables and ART adherence status. 259(73.6%) participants were adherent (&gt;=95%) and 93(26.4%) were non-adherent (&lt;95%) to the prescribed dose of ARV drugs over the past seven days prior to the interview. The main reasons for skipping the prescribed ARV drugs were, busyness (78.5%), having too many pills (71%), felt depressed (68.8%), taking the drugs reminded HIV infected (66.7%), did not want other see (62.4%), and felt asleep(60.2%). The last stepwise regression analysis revealed that, educational status, knowledge of HIV/AIDS, use of additional drugs and access to reliable pharmacy were significantly associated with ART adherence status. So, efforts to maximize ART adherence should focus on addressing these associated significant factors.