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Article
Reasons for Missing Antiretroviral Therapy: Results from a Multi-Country Study in Tanzania, Uganda, and Zambia
PLoS ONE
  • Olivier Koole, London School of Hygiene and Tropical Medicine
  • Julie A. Denison, Social and Behavioral Health Sciences, FHI 360, Washington, DC
  • Joris Menten, Institute of Tropical Medicine
  • Sharon Tsui, Social and Behavioral Health Sciences, FHI 360, Washington, DC
  • Fred Wabwire-Mangen, Makerere University College of Health Sciences
  • Gideon Kwesigabo, Muhimbili University of Health and Allied Sciences
  • Modest Mulenga, Tropical Diseases Research Center, Zambia
  • Andrew F. Auld, Division of Global HIV/AIDS, Center for Global Health
  • Simon G. Agolory, Division of Global HIV/AIDS, Center for Global Health
  • Ya Diul Mukadi, FHI 360, Haiti
  • Eric van Praag, FHI 360, Tanzania
  • Kwasi Torpey, FHI 360, Zambia
  • Seymour Williams, Massachusetts General Hospital
  • Jonathan Kaplan, Division of Global HIV/AIDS, Center for Global Health
  • Aaron Zee, Division of Global HIV/AIDS, Center for Global Health
  • David Bangsberg, Portland State University
  • Robert Colebunders, Institute of Tropical Medicine
Document Type
Article
Publication Date
1-1-2016
Subjects
  • HIV infections -- Sub-Saharan Africa -- Treatment,
  • AIDS (Disease) -- Sub-Saharan Africa -- Treatment,
  • Patient compliance -- Sub-Saharan Africa -- Qualitative studies,
  • Antiretroviral therapy
Physical Description
15 pages
Abstract

Objectives To identify the reasons patients miss taking their antiretroviral therapy (ART) and the proportion who miss their ART because of symptoms; and to explore the association between symptoms and incomplete adherence.

Methods Secondary analysis of data collected during a cross-sectional study that examined ART adherence among adults from 18 purposefully selected sites in Tanzania, Uganda, and Zambia. We interviewed 250 systematically selected patients per facility (≥18 years) on reasons for missing ART and symptoms they had experienced (using the HIV Symptom Index). We abstracted clinical data from the patients’ medical, pharmacy, and laboratory records. Incomplete adherence was defined as having missed ART for at least 48 consecutive hours during the past 3 months.

Results Twenty-nine percent of participants reported at least one reason for having ever missed ART (1278/4425). The most frequent reason was simply forgetting (681/1278 or 53%), followed by ART-related hunger or not having enough food (30%), and symptoms (12%). The median number of symptoms reported by participants was 4 (IQR: 2–7). Every additional symptom increased the odds of incomplete adherence by 12% (OR: 1.1, 95% CI: 1.1–1.2). Female participants and participants initiated on a regimen containing stavudine were more likely to report greater numbers of symptoms.

Conclusions Symptoms were a common reason for missing ART, together with simply forgetting and food insecurity. A combination of ART regimens with fewer side effects, use of mobile phone text message reminders, and integration of food supplementation and livelihood programmes into HIV programmes, have the potential to decrease missed ART and hence to improve adherence and the outcomes of ART programmes.

Description

At the time of writing, David Bangsberg was affiliated with Massachusetts General Hospital, Boston, and Harvard Medical School.

DOI
10.1371/ journal.pone.0147309
Persistent Identifier
http://archives.pdx.edu/ds/psu/18543
Publisher
Public Library of Science
Citation Information
Koole O, Denison JA, Menten J, Tsui S, Wabwire-Mangen F, Kwesigabo G, et al. (2016) Reasons for Missing Antiretroviral Therapy: Results from a Multi-Country Study in Tanzania, Uganda, and Zambia. PLoS ONE 11(1): e0147309. doi:10.1371/ journal.pone.0147309