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Adherence and Treatment Response Among HIV-1-Infected Adults Receiving Antiretroviral Therapy in a Rural Government Hospital in Southwestern Uganda

Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda, fbaj{at}yahoo.com

Eric J. Arts, PhD

Division of Infectious Diseases, Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio

Daniel J. Tisch, PhD, MPH

Department of Epidemiology and Biostatistics Case Western Reserve University School of Medicine, Cleveland, Ohio

Charles H. King, MD

Department of Epidemiology and Biostatistics Case Western Reserve University School of Medicine, Cleveland, Ohio

Sara M. Debanne, PhD

Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine, Cleveland, Ohio

Ajay K. Sethi, PhD, MHS

Department of Epidemiology and Biostatistics Case Western Reserve University School of Medicine, Cleveland, Ohio, Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin

Background. Large-scale, government-based antiretroviral therapy (ART) programs in rural areas of resource-poor countries remain largely unevaluated. Methods. We conducted a retrospective review of all patients receiving ART (n = 399) to assess survival and retention in care and a prospective evaluation of patients on ART for at least 6 months (n = 175). We used 3-day self-report to measure adherence. Results. The probability (95% confidence interval [CI]) of surviving and remaining in care was 0.76 (0.72, 0.81) at 1 year. Men and patients with advanced disease were more likely to die or be lost to follow-up. At baseline, 149 (85%) reported 100% adherence. Nonadherence was associated with lack of suppression of viral replication (odds ratio [OR] = 4.5; 95% CI: 1.8, 11.5). Missing a scheduled clinic visit and lack of disclosure of HIV status were associated with nonadherence. Conclusion. Viral suppression was high, but counseling to include HIV disclosure to family and keeping scheduled clinic appointments may improve long-term adherence and treatment outcomes.

Key Words: HIV • antiretroviral therapy • adherence • virologic suppression • rural settings • Uganda

This version was published on March 1, 2009

Journal of the International Association of Physicians in AIDS Care (JIAPAC), Vol. 8, No. 2, 139-147 (2009)
DOI: 10.1177/1545109709332470


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