Adherence to HIV antiretroviral therapy Part II: which interventions are effective in improving adherence?

Predictors of Suboptimal Adherence Among Children on Antiretroviral Therapy in Southern Ethiopia: A Multicenter Retrospective Follow-Up Study

Objectives: Despite increased access to and availability of antiretroviral therapy, the program's effectiveness is primarily affected by treatment adherence. Therefore, this study aimed to determine the magnitude and predictors of suboptimal adherence among children on ART in Southern Ethiopia. Methods: A multicenter retrospective study was conducted among human immunodeficiency virus (HIV) infected children in Gamo and South Omo zone public health facilities. To identify factors associated with suboptimal adherence, a binary logistic regression model was fitted. Variables with a p-value ≤0.25 in bivariable logistic regression analysis were included in multivariable logistic regression analysis. p-value <0.05 was used to declare statistical significance. Results: The suboptimal adherence was determined to be 30.3% (95% CI: 25.5%, 35.6%). Advanced clinical stage, hemoglobin level <10 mg/dL, unchanged initial regimen, and non-disclosure of HIV sero-status were significant predictors of suboptimal adherence. Conclusion: Suboptimal adherence is a significant public health problem in the study setting. Therefore, designing interventions towards improving adherence is needed especially for children with poor clinical characteristics.

Levels of Adherence and Associated Factors Among Children on ART Over Time in Northwest, Ethiopia: Evidence from a Multicenter Follow-Up Study

Background

Despite the increased availability of antiretroviral therapy (ART), its success depends on a high level of adherence to a life-long antiretroviral therapy. However, the extent and factors associated with adherence to ART are not well known, especially in the current study setup. Therefore, this study aimed to assess the level of adherence and associated factors among children on ART in Northwest, Ethiopia.

Methods

A retrospective follow-up study was conducted on human immunodeficiency virus (HIV)-infected children receiving ART at South Gondar public hospitals. Children receiving ART from January 1, 2015, to November 30, 2020, were included in the study. A computer-generated simple random sampling technique was employed. The data were entered into the EpiData version 3.1 and analyzed by STATA 14 statistical software. Bivariable logistic regression was fitted for each predictor variable. Moreover, those variables having a p-value ≤0.25 in bivariate analysis were fitted into a multivariable logistic regression model. P-value <0.05 was used to declare significance.

Results

A total of 363 HIV-infected children were involved in the study. From 363 HIV-infected children, the level of adherence to ART was found to be 78.2%, 95% CI (73.6, 82.2). TB co-infection [adjusted odds ratio (AOR) = 3.8, 95% CI (1.41, 10.1)], short duration on ART (AOR = 3.4, 95% CI (1.60, 7.20)), treatment failure (AOR = 10.2, 95% CI (3.95, 26.2)), and Zidovudine containing ART regimen (AOR = 3.5, 95% CI (1.1, 10.9)) were significant predictors of poor adherence.

Conclusion

The current study showed that the level of adherence to ART was found to be low TB co-infection, short duration of ART, Zidovudine-containing ART regimen, and treatment failure were found to be significantly associated with poor adherence. Further studies on adherence rate and its determinants with multiple adherence measurements using prospective and multicenter studies were recommended.

Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies

The success of potent antiretroviral treatment for HIV infection is primarily determined by adherence. We systematically review the evidence of effectiveness of interventions to increase adherence to antiretroviral treatment in sub-Saharan Africa. We identified 27 relevant reports from 26 studies of behavioural, cognitive, biological, structural, and combination interventions done between 2003 and 2010. Despite study diversity and limitations, evidence suggests that treatment supporters, directly observed therapy, mobile-phone text messages, diary cards, and food rations can effectively increase adherence in sub-Saharan Africa. However, some interventions are unlikely to have large or lasting effects, and others are effective only in specific settings. These findings emphasise the need for more research, particularly for randomised controlled trials, to examine the effect of context and specific features of intervention content on effectiveness. Future work should assess intervention targeting and selection of interventions based on behavioural theories relevant to sub-Saharan Africa.