170 Ability to Purchase and Secure Stable Therapy are Significant Predictors of Non-adherence to Antiretroviral Therapy in Kampala, Uganda J Byakika-Tusiime*1,2, JH Oyugi1,2,3, WA Tumwikirize1, ET Katabira1,2, PN Mugyenyi 2,4, DR Bangsberg2,3 1Makerere Univ, Kampala, Uganda; 2Academic Alliance for AIDS Care and Prevention in Africa, Kampala, Uganda; 3Univ of California at San Francisco; and 4Joint Clin Res Ctr, Kampala, Uganda
Background: Seventy-two percent (72%) of people living with HIV/AIDS are in Sub-Saharan Africa. Decreasing prices of antiretroviral therapy (ART) has expanded access to therapy in Sub-Saharan Africa. While ART adherence is closely tied to viral suppression, progression to AIDS and mortality, the level of and barriers to adherence in Sub-Saharan Africa are poorly understood. We investigated adherence to therapy in patients receiving ART in three treatment centers in Kampala, Uganda.
Methods: HIV+ patients (pts) self-purchasing and taking ART were recruited from the Joint Clinical Research Center, Nsambya Hospital and Mildmay International. The number of missed doses over the last 4 days was assessed by structured pt interview and dichotomized at ±95% adherence and ±80% adherence. Potential predictors of adherence were assessed with both structured pt interview and unstructured qualitative interviews. Independent predictors of non-adherence were assessed with multivariate logistic regression.
Results: A total of 304 HIV-infected persons on ART were enrolled into the study. Mean age was 39 yrs and 53% were female; 20% were employed and median monthly income was between 100,000-500,000 Ugandan shillings (Ushs) ($56-$278 U.S. dollars). Median ART treatment duration was 7-12 months; 32.7% and 28.6% of individuals reported <95% and <80% adherence, respectively; 60% were on 3 or more antiretroviral medications, 30% were on dual therapy, and 10% were on monotherapy. Factors associated with non-adherence at the 95% level were forgetfulness (OR = 5.86, 2.02-17.04); low monthly income [50,000 Ushs-100,000 Ushs (OR = 2.61, 1.31-5.22), 100,000 Ushs-500,000 Ushs (OR = 3.20, 1.07-9.57)] and self-efficacy (OR = 0.41, 0.19-0.90). Factors associated with non-adherence at the 80% level were forgetfulness (OR = 5.64, 1.45-21.96); monthly income 50,000 Ushs-100,000 Ushs (OR = 3.02, 1.42-6.40); shortage of drugs due to lack of money (OR = 0.4, 0.18-0.93), and inaccessibility of drugs (OR = 7.56, 1.52-37.58). Qualitative interviews indicated that ability to purchase and secure stable therapy were important barriers to sustained adherence.
Conclusions: Levels of self reported adherence in pts receiving ART in Kampala are comparable to levels in resource rich settings. Forgetfulness and self efficacy are associated with adherence to therapy similar to resource rich settings. Unlike resource rich settings, however, ability to purchase and secure a stable supply of therapy are major barriers to adherence.
