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Background:  Prevention of mother to child transmission (PMTCT) is a global priority, but not inclusive of continued antiviral ART. The Mother to Child Transmission Plus  (MTCT+) Program provides free ART to all HIV-infected members in a household. We used an observational prospective cohort study to determined the distribution of adherence using multiple measures in this setting where all HIV+-eligible patients in a household were receiving treatment.

Methods:  Level of adherence was measured using 3 methods:  home based Unannounced Pill Count, 3-day self-report, and the 30-day Visual Analogue Scale (VAS). Adherence was assessed every 4 weeks for 3 months. Viral load was determined at baseline and at 12 weeks. CD4 count was determined at baseline. Continuous variables were summarized using the median, mean, and standard deviation. Adherence status was determined using a 95% cut-off benchmark where > 95% adherence was categorized as adherent, while <95% adherence was non adherent. Forty-four participants were enrolled into the study. Of these, twenty-eight (63.6%) with 12 weeks of follow up were included in the analysis. Four of the participants (14.29%) were female children with a mean age of 1.5 years + 3.0. Twenty of the participants (71.4%) were female, and 8 (28.6%) were men. Two of the participants were from the same household. Five participants (17.9%) had at least 1 other household member on ART. Mean age for the participants was 29.50 years + 13.52. Participants reported a mean monthly income of $60 USD + 75. Ten (45.5%) of the adult participants had only primary level education. Mean age at first sex was 16.35 years + 3.05.

Results:  Pretreatment CD4 (median) was 167 cells /uL while pretreatment viral load was 509,954 copies/mL (log VL = 5.71). Median viral load at 12 weeks was 135copies/mL (log VL = 2.13) with 88.9% below 400 copies per mL. Mean adherence was 97.3% (95% confidence interval (CI) 95.0 to 98.8), 99.2% (95% CI 98.0 to 100.4), 99.8% (95% CI 99.6 to 100), while median adherence was 99%, 100%, and 100% by home-based Unannounced Pill Count, 3-day self-report, and 30-day VAS, respectively. In addition, 88.5%, 96.2%, and 100% of the participants reported > 95% adherence by the 3 measures, respectively.

Conclusions:  We found adherence levels near 100% and near complete viral suppression when antiretroviral therapy was provided free to all HIV-infected members in a Ugandan household.

Keywords: Adherence; Antiretroviral Therapy; MTCT+