Adherence to antiretroviral therapy by HIV infected patients in rural UMkhanyakude District, South Africa.
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Date
2008
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Abstract
The background.
HIV and AIDS is a huge problem in sub-Saharan Africa where an estimated 22.5
million people were living with HIV in 2007.1 South Africa has the worst epidemic in
the world.1 There were about 5.5 million people living with HIV and 1000 AIDS deaths
daily in South Africa by the end of 2005.17 In 2007 the number of people living with
HIV in South Africa increased to 5.7 million.1
The HIV prevalence in Umkhanyakude district, KwaZulu Natal, where Hlabisa subdistrict
is situated, amongst public antenatal clinic attenders was 39.8% in 2007.19 AIDS
is the cause of 50.0% of deaths in the Hlabisa sub-District.15
In 2003 the South African government decided to provide antiretroviral therapy (ART)
in the public health sector, giving hope to thousands of people who are in need of this
intervention to improve their quality of life and reduce premature deaths.7,13 However
adherence to antiretroviral drugs is essential for successful treatment.
Adherence to antiretroviral therapy in South Africa as in other African countries was
expected to be low31 (<95.0%), however, in a study that was done in Cape Town during
1996 – 2001, the authors concluded that adherence was high.28 The aim of that study
was to identify predictors of low adherence (<95.0%) and failure of viral suppression
(>400 HIV copies/mm3). Pill counts and records of treatment refills from pharmacy
were used to measure adherence.28 The results revealed no significant difference in
adherence between patients on protease inhibitor based regimens and/or those on nonnucleoside
based regimens nor with socioeconomic status, sex and HIV stage.
Independent predictors of low adherence were English language speaking, age, and
three times per day dosing. The following were found to be independent predictors of
failure of viral suppression: baseline viral load, <95.0% adherence, age and dual
nucleoside therapy.28This study however was done in an urban area before the
antiretroviral therapy (ART) roll out in South Africa when the cost of treatment limited
the accessibility of ART. These patients may have been different to patients who access
free treatment in public health facilities today.
Other South African studies have also reported good adherence rates.39,40 In another
study in Soweto, South Africa, adherence was high, 88.0% of patients achieved >
95.0% goal, 9.0% achieved 90.0-95.0% adherence and only 3.0% achieved <90.0%.39In
a study done at Khayelitsha, adherence was also high, viral load level was < 400 in
88.1%, 89.2%, 84.2%, 75% and 69.7% of patients at 3, 6, 12, 18 and 24 months.40
However, Soweto and Khayelitsha are urban and different from Hlabisa, and it is
difficult to generalize these results to the sub-district. This study intended to assess how adherent patients are to antiretroviral therapy in a typical rural district in order to
inform policy to enhance adherence to ART.
Description
Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.
Keywords
Antiretroviral agents--KwaZulu-Natal--UMkhanyakude District., HIV-positive persons--Treatment--KwaZulu-Natal--UMkhanyakude District., Theses--Public health medicine.