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Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru: a cross-sectional study.

ABSTRACT: BACKGROUND:There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles, evaluating the clinical management strategies, and analyzing the relationships between the variables and adherence of PLHIV managed at a regional HIV clinic in Lambayeque Province (Northern Peru). METHODS:This was a cross-sectional study with 180 PLHIV adults, non-randomly but consecutively selected with self-reported ART compliance (78.2% of the eligible population). The PLHIV profile (PLHIV-Pro) and the Simplified Medication Adherence Questionnaire (SMAQ) were used to collect sociodemographic information, clinical variables, and data specific to ART adherence. Descriptive analysis of sociodemographic and clinical characteristics was performed. Bivariate analysis was performed with the Mann-Whitney test, Chi square test, and Yates correction. RESULTS:The 180 PLHIV sample included 78.9% men, 49.4% heterosexual, 45% with a detectable HIV-1 viral load less than 40 copies/ml, 58.3% not consistently adherent, and only 26.1% receiving Tenofovir?+?Lamivudine?+?Efavirenz. Risk factors significant for non-adherence included concurrent tuberculosis, discomfort with the ART regime, and previous pauses in ART. Multivariate analysis of nested models indicated having children is a protector factor for adherence. CONCLUSIONS:Self-reported adherence appeared to be low and the use of first-line therapy is not being prescribed homogeneously. Factors associated with nonadherence are both medical and behavioral, such as having tuberculosis, pausing ART, or experiencing discomfort with ART. The Peruvian government needs to update national technical standards, monitor medication availability, and provide education to health care professionals in alignment with evidence-based guidelines and international recommendations. Instruments to measure adherence need to be developed and evaluated for use in Latin America.

SUBMITTER: Leyva-Moral JM

PROVIDER: S-EPMC6714391 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

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Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru: a cross-sectional study.

Leyva-Moral Juan M JM Loayza-Enriquez Blanca K BK Palmieri Patrick A PA Guevara-Vasquez Genesis M GM Elias-Bravo Ursula E UE Edwards Joan E JE Feijoo-Cid María M Davila-Olano Lucy Y LY Rodriguez-Llanos Juan R JR Leon-Jimenez Franco E FE

AIDS research and therapy 20190828 1

<h4>Background</h4>There are approximately 72,000 people living with HIV/AIDS (PLHIV) in Peru. Non-adherence to antiretroviral therapy (ART) is the most important factor for therapeutic failure and the development of resistance. Peru has achieved moderate progress in meeting the 90-90-90 targets, but only 60% of PLHIV receiving ART are virally suppressed. The purpose of this study was to understand ART adherence in the Peruvian context, including developing sociodemographic and clinical profiles ...[more]

PMID: 31462291

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Project description:BackgroundAdherence to ART is the primary determinant of viral suppression and the risk of transmission, disease progression and death. Adherence of at least 95% is needed for optimal suppression. This study aimed at determining the adherence to Anti-Retroviral Therapy (ART) and its associated factors among People Living with HIV and AIDS in ART Center of Chitwan, Nepal.MethodsA descriptive cross-sectional study was conducted among 231 clients aged 18 years to 49 years taking ART from Bharatpur Hospital of Chitwan and those who have been enrolled in ART for at least 6 months, were interviewed. Systematic Sampling technique was used. Semi-structured questionnaire was prepared by taking reference from the AIDS Clinical Trial group questionnaire (ACTG). Adherence was measured by patient self report. Data was entered Epi Data 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) software where the P value of < 0.05 was accepted as being statistically significant. The independent variables which were found significant at p-value 0.10 in bivariate analysis were fitted in multivariable logistic regression model. Multivariable logistic regression model was performed to know the net effect of the independent variables on Adherence to ART medication.ResultsThe overall adherence in the last month was found to be 87.4%. Wrist watch and mobiles were seen as a facilitating factor for taking ART on time as clients taking ART used to set alarm to get informed of the medication time. Adherence was associated with female sex (AOR = 10.550 CI: 1.854-60.046), family consisting only parents and their children (AOR = 4.877, CI: 1.246-19.079), having no habit of taking alcohol (AOR = 5.842 CI: 1.294-26.383), HIV duration of more than 3 years (AOR = 10.055 CI: 2.383-42.430), picking up ART medications on their own (AOR = 7.861, CI: 1.670-36.998) and not having side effects of ART (AOR = 8.832, CI: 2.059-37.890).ConclusionIdentifying and evaluating the problems faced by ARV drug users can foster the achievement of ART related goals and addressing ART related problems in a rational way. Effective and appropriate monitoring of non adherence behaviors can help patients increase adherence level fostering improvement in treatment outcome.

Project description:Health-related quality of life (HRQOL) has become a concept commonly used in the related research. Using the World Health Organization Quality of Life Questionnaire for Brief Version (WHOQOL-BREF), this study evaluated the Quality of Life (QOL) of people living with HIV/AIDS (PLWHA) in Zhejiang province, China, and assessed the influences of demographic, laboratory and disease-related variables on QOL. This cross-sectional study was conducted among PLWHA aged ? 18 years in Taizhou municipality, Zhejiang province, China, between August 1 and October 31, 2014. A multiple linear regression model was used to analyze the influential factors. Of 403 subjects, 72.48% were male, 72.46% had received a high- school or above education, 94.79% were of Han ethnicity, and 65.51% were non farmers. The total score of QOL was 15.99±1.99. The scores of QOL in physiological, psychological, social relation, and environmental domains were 14.99 ±2.25, 14.25 ±2.12, 13.22 ±2.37, and 13.31 ±1.99 respectively. Except the total score of QOL and the score of environmental domain (p<0.05), the scores in other domains had no significant difference with the results of the national norm level. The multiple linear regression model identified the physical domain related factors to be age (? = -0.045), CD4 count (? = 0.002), and ART adherence(? = 1.231). And it also showed that psychological domain related factors included CD4 count (? = 0.002) and WHO clinical stage (? = -0.437); social domain related factors included WHO clinical stage (? = -0.704) and ART adherence (? = 1.177); while environmental domain related factors included WHO clinical stage (? = -0.538), educational status(? = 0.549) and ART adherence(? = 1.078).Those who are young, with higher level of education, higher CD4 count and good access and adherence of ART, are likely to have better QOL among PLWHA in Zhejiang province. This suggests that in addition to ART, many other factors should be taken into consideration to improve the QOL of PLWHA. The relatively lower scores the subjects received in social relation and environmental domains also suggest that social relation and environmental interventions need to be strengthened.

Project description:BackgroundSuicide is a serious cause of mortality worldwide and is considered as a psychiatric emergency. People living with HIV/AIDS (PLWHA) have higher rates of suicidal behavior than the general population. This study assessed the prevalence and verified the syndemic effect of psychosocial health conditions on suicidal ideation among PLWHA in China.MethodsAn institutional-based cross-sectional study was conducted from July to August 2016 in Nanjing, China, using a self-report questionnaire. Sociodemographic characteristics, infection status, psychosocial variables and suicide ideation reports of participants were collected. Logistic regressions were used to identify potential factors associated with suicidal ideation and to verify the syndemic effect of psychosocial factors. Additionally, odds ratios (ORs) with 95% confidence intervals (95% CI) were computed.ResultsIn total, four hundred sixty-five PLWHA participated, 31.6% (n = 147) of whom had suicidal ideation. The results from univariate analysis showed that older age, low education level, being married, having children, and psychosocial variables (high perceived stigma, depression, low self-esteem, social support and resilience) were significantly associated with increased suicidal ideation. Multiple logistic regression models revealed that depression (OR = 2.70, 95%CI = 1.62-4.51), perceived stigma (OR = 1.97, 95%CI = 1.17-3.32), and low social support (OR = 1.85, 95%CI = 1.08-3.20) and self-esteem (OR = 4.11, 95%CI = 2.06-8.16) were statistically significant. PLWHA with at least two psychosocial health problems were nearly 5 times more likely (OR = 4.72, 95% CI 3.11-7.17) to have had suicidal ideation.ConclusionsSuicidal ideation is frequent among PLWHA in China and is consistent with prevalence estimates from abroad. Psychosocial health problems were the determining factors associated with suicidal ideation, and a syndemic effect of psychosocial health conditions was confirmed in predicting suicidal ideation. Therefore, early screening of high-risk groups for suicidal ideation and more psychosocial health care among PLWHA are needed.

Project description:IntroductionFollowing global efforts to increase antiretroviral therapy (ART) access and coverage, Ethiopia has made significant achievement with a 6.3% annual decline in the HIV/AIDS incidence rate between 1990 and 2016. Such success depends not only on access to ART but also on attaining optimum treatment adherence. Emerging studies in Ethiopia has shown the increasing prevalence of poor adherence and lack of the desired viral suppression, but the extent and factors associated with non-adherence to ART are not well known, especially in the current study setup. In this study, we examined the magnitude and factors associated with treatment and non-adherence to ART among people living with HIV in Benishangul-Gumuz Regional State, northwest Ethiopia.MethodsAn institutional facility based cross-sectional descriptive study was carried out among adult people living with HIV/AIDS from mid-December 2016 to February 2017 with only 98.9% response rate. Sociodemographic factors (age, gender, marital status and residential area), economic factors (educational status, income, asset possession, employment status, dietary diversity, nutritional status and food security), and clinical characteristics (CD4 count, duration on ART and history of opportunistic infections) were explanatory variables. ART non-adherence was measured using a visual analogue scale (VAS). We used binary logistic regression and subsequent multivariate logistic regression analysis to determine the factors associated with ART non-adherence.ResultOverall, 39.7% of the participants were found non-adherent to ART. Strong association was found between non-adherence to ART and young age below 25 years (AOR: 4.30, 95% CI [1.39-3.35]; p = 0.011), urban residential area (AOR: 2.78, CI [1.23-7.09], p = 0.043), lack of employment (AOR: 1.75, 95% CI [1.05-2.91], p = 0.032), food insecurity (AOR: 2.67, 95% CI [7.59-8.97]; p < 0.0001), malnutrition (AOR: 1.55, 95% CI [1.94-2.56]; p = 0.027) and opportunistic infections (AOR: 1.81, 95% CI [1.11-2.97]; p = 0.018).ConclusionThe prevalence of non-adherence to ART in this study was high. Sociodemographic and economic factors such as young age of below 25 years, urban residential area, lack of employment, food insecurity, malnutrition and opportunistic infections were among the factors associated with non-adherence to ART.

Dataset Information

Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru: a cross-sectional study.

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Adherence to antiretroviral therapy and the associated factors among people living with HIV/AIDS in Northern Peru: a cross-sectional study.

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