Background:  Recent research has stressed the need for strict adherence to ART to avoid development of drug resistance and to enhance good treatment outcomes. However, published literature on HAART discontinuation and modification among African populations is scarce. We sought to determine the prevalence and to identify the factors associated with these phenomena in our resource-limited setting.
Methods:  Patients receiving HAART were recruited into a cross-sectional study from 2 treatment centers in Kampala, Uganda. Discontinuation and modification were assessed by self-report using semi-structured quantitative and unstructured qualitative interviews. Discontinuation was defined as the simultaneous stopping of all ART for at least a month, and modification as the changing of at least 1 of the ART used as part of an initial HAART regimen. Multivariate logistic regression was used to identify factors independently associated with discontinuation and modification of HAART.
Results:  We evaluated 686 individuals receiving HAART. The median CD4 cell count was 175 cells/µL, of whom 94 (13.7%) had ever discontinued therapy, while 175 (25.5%) had ever modified their regimen. The most frequent reason for discontinuing therapy was drug cost (43%), whereas avoidance of adverse events (71.8%) was commonest for therapy modification. Factors associated with discontinuation were:  HAART-experience (OR = 3.70, CI 2.13 to 6.25), use of alternative medicines (OR = 2.18, 95%CI 1.06 to 4.47), history of hospitalization (OR = 2.36, CI 1.32 to 4.20), <1 year duration on HAART (OR = 11.11, CI 5.00 to 25.00), and year of initiation 2004 or earlier vs since 2004 (OR = 4.42, CI 1.90 to 10.47). Modification was associated with >3 months’ duration on therapy (OR = 3.13, CI 1.16 to 8.33), year of initiation 2004 or earlier vs since 2004 (OR = 2.10, CI 1.02 to 4.31), married vs unmarried (OR = 0.61, CI 0.37 to 0.98), and low regimen pill burden (OR = 0.04, CI 0.02 to 0.08).
Conclusions:  Rates of discontinuation and modification of ART were significant, posing a challenge to the limited number of treatment options in our resource-limited setting.