Outcomes and Determinants of Treatment Adherence among HIV Patients on Art: Evidence from a Retrospective Cohort Study in Selected Clinics in Windhoek, Namibia

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DOI: 10.21522/TIJPH.2013.07.02.Art009

Authors : Ntumba A, Nakaluudhe J, Kazembe L

Abstract:

Background: Treatment adherence is critical in the management of patients receiving antiretroviral therapy (ART).

Objective: To investigate determinant of treatment adherence and health-related outcomes after ART initiation in Windhoek, Namibia.

Methods: We used data from retrospective cohort from January 2010 to December 2015. We defined ART adherence at 95%, while non-adherence at <95% . We examined two outcomes: viral suppression and body weight at 6 and 12 months.. We then investigated the relationship between patient individual outcomes and treatment adherence. We applied multivariate binary and multinomial logistic regression models to examine the determinants of ART adherence and outcomes.

Results: Of 943 patients on ART, 58.9% were female, 82.1% aged between 25 to 49 years old and 86.6% ever married. Viral suppression at 6 months (p<0.000), and 12 months (p<0.000), and patients’ body weight at 6 months (p = 0.009) were significant more pronounced with ART adherence.. Regarding determinants of ART adherence, the results showed age between 25 and 29 years, and married was associated with higher adherence (OR=1.94, CI: 1.12-3.14). Patients at WHO clinical stage-I were more likely to adhere to treatment (OR=1.28, 95% CI: 1.01-1.73), while those at clinical stage-II were less likely (OR=0.41, 95% CI: 0.18-0.91, p-value = 0.028).

Conclusion: ART adherence leads to better outcomes.. Both demographic and clinical factors were associated with ART adherence. Future research should consider evaluating the effect of adherence to an extended coverage of clinics, and allow collecting more detailed factors that are associated with treatment adherence.

Keywords: HIV; Antiretroviral Therapy; ART adherence; viral suppression; multinomial logistic regression.

References:

[1].therapy in a rural South African programme. PLoS One. 2011;6(5): e19201.

Duwell MM, Knowlton AR, Nachega JB, et al. Patient-Nominated, Community-Based HIV Treatment Supporters: Patient Perspectives, Feasibility, Challenges, and Factors for Success in HIV-Infected South African Adults. AIDS Patient Care and STDs. 2013;27(2):96-102. doi:10.1089/apc.2012.0348.

[2].Fonsah JY, Njamnshi AK, Kouanfack C, Qiu F, Njamnshi DM, Tagny CT, et al. (2017) Adherence to Antiretroviral Therapy (ART) in Yaoundé-Cameroon: Association with Opportunistic Infections, Depression, ART Regimen and Side Effects. PLoS ONE 12(1): e0170893. https://doi.org/10.1371/journal.pone.0170893.

[3].Heestermans et al. (2016) Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review. BMJ Glob Health 2016; 1: e000125. Doi: 10.1136/bmjgh-2016-000125.

[4].Hirsch-Moverman Y, Daftary A, Yuengling KA, et al. Using mHealth for HIV/TB Treatment Support in Lesotho: Enhancing Patient–Provider Communication in the START Study. Journal of Acquired Immune Deficiency Syndromes. 2017;74(Suppl 1):S37-S43. doi:10.1097/QAI.0000000000001202.

[5].Johnson MO, Dilworth SE, Taylor JM, Darbes LA, Comfort ML, Neilands TB. Primary Relationships, HIV Treatment Adherence, and Virologic Control. AIDS and behavior. 2012;16(6):1511-1521. doi:10.1007/s10461-011-0021-0.

[6].Ketema AK, Weret ZS. Assessment of adherence to highly active antiretroviral therapy and associated factors among people living with HIV at Debrebrihan Referral Hospital and Health Center, Northeast Ethiopia: a cross-sectional study. HIV/AIDS - Research and Palliative Care, 2015:7:75—81.

[7].Kheswa, G. J. (2017). Exploring the Factors and Effects of Non-Adherence to Antiretroviral Treatment by People Living with HIV/AIDS. Indo-Pacific Journal of Phenomenology. 17:1, 1-11, Doi: 10.1080/20797222.2017.1280923.

[8].Markos E, Worku A, Davey G. Adherence to antiretroviral treatment in PLWHA at Yirgalem Hospital, South Ethiopia. Ethiopian Journal of Health Development. 2009;22(2):174–179.

[9].Mathes T, Jaschinski T, Pieper D. Adherence influencing factors – a systematic review of systematic reviews. Archives of Public Health. 2014;72:37. doi:10.1186/2049-3258-72-37.

[10]. Nachega JB, Knowlton AR, Deluca A, Schoeman JH, Watkinson L, Efron A, Chaisson RE, Maartens G.Treatment supporter to improve adherence to antiretroviral therapy in HIV-infected South African adults. A qualitative study. J Acquir Immune Defic Syndr. 2006 Dec 1;43 Suppl 1:S127-33.

[11]. Nachega, B. J., Mills, E. J. & Schechter, M. (2010). Antiretroviral therapy adherence and retention in care in middle-income and low-income countries: current status of knowledge and research priorities, Current Opinion in HIV and AIDS. vol. 5, no. 1, pp. 70–77.

[12]. Ncaca LN, Kranzer K, Orrell C. Treatment interruption and variation in tablet taking behaviour results in viral failure: a case control study of Cape Town, South Africa. PloS One. 2011;6(8):e23088.

[13]. Noens et al. (2009). Prevalence, determinants, and outcomes of nonadherence to imatinib therapy in patients with chronic myeloid leukemia: the ADAGIO study. Prepublished online as Blood First Edition paper; Doi: 10.1182/blood-2008-12-196543.

[14]. Ministry of Health and Social Services (2016). National Guidelines for Antiretroviral Therapy. Fifth edition 2016. Windhoek. Namibia.

[15]. Olowookere et al. (2016). Effects of adherence to antiretroviral therapy on body mass index, immunological and virological status of Nigerians living with HIV/AIDS. Alexandria University Faculty of Medicine; Alexandria Journal of Medicine (2016) 52 51-54.

[16]. Reda, A. A. & Biadgilign, S. (2012). Determinants of Adherence to Antiretroviral Therapy among HIV-Infected Patients in Africa. Hindawi Publishing Corporation AIDS Research and Treatment Volume 2012, Article ID 574656, doi:10.1155/2012/574656.

[17]. Rougemont, M., Stoll, E. B., Elia, N & Ngang, P. (2009). Antiretroviral treatment adherence and its determinants in Sub-Saharan Africa: a prospective study at Yaounde Central Hospital, Cameroon.

[18]. Peltzer, K., Friend-du Preez, N., Ramlagan, S. & Anderson, J. (2010). Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa. Retrieved from http://www.biomedcentral.com/1471-2458/10/111; BMC Public Health 2010, 10:111.

[19]. UNAIDS (2016). Global AIDS update. Retrieved from

http://www.unaids.org/en/resources/documents/2016/Global-AIDS-update-2016. Accessed on May 19, 2017.

[20]. UNAIDS (2016). 90-90-90 On the right track towards the global target. Retrieved from https://reliefweb.int/sites/reliefweb.int/files/resources/90_90_90_Progress_ReportFINAL pdf.

[21]. UNAIDS (2017). UNAIDS data 2017. Retrieved from

http://www.unaids.org/sites/default/files/media_asset/20170720_Data_book_2017_en.pdf.

[22]. WHO (2017). Antiretroviral Therapy. Available at http://www.who.int/topics/antiretroviral_therapy/en. Accessed on May 20, 2017.