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Antiretroviral adherence in a resource-poor setting

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Abstract

Adherence is key to successful antiretroviral therapy (ART). Many countries with increased HIV prevalence and the greatest need for ART have limited health resources. Recent assumptions that the adherence required for successful ART will not be achieved in resource-poor settings have led to calls for caution in expanded access programs. New studies from Africa refute this, showing excellent adherence and virologic outcomes. Major factors contributing to adherence or nonadherence are whether the drug is accessed for free or is self-funded, patient preparedness for use of ART, stigmatization related to being HIV-positive, and ease of use of regimen.

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References and Recommended Reading

  1. Arnsten JH, Demas PA, Farzadegan H, et al.: Antiretroviral therapy adherence and viral suppression in HIV-infected drug users: comparison of self report and electronic monitoring. Clin Inf Dis 2001, 33:1417–1423.

    Article  CAS  Google Scholar 

  2. Bangsberg D, Hecht F, Charlebois ED, et al.: Adherence to protease inhibitors, HIV-1 viral load and development of drug resistance in an indigent population. AIDS 2000, 14:357–366.

    Article  PubMed  CAS  Google Scholar 

  3. Paterson D, Swindells S, Mohr J, et al.: Adherence to protease inhibitor therapy and outcomes inpatients with HIV infection. Ann Intern Med 2000, 133:21–30.

    PubMed  CAS  Google Scholar 

  4. McNabb J, Ross JW, Abriola K, et al.: Adherence to highly active antiretroviral therapy predict virologic outcome at an inner-city immunodeficiency virus clinic. Clin Inf Dis 2001, 33:700–705.

    Article  CAS  Google Scholar 

  5. Orrell C, Bangsberg D, Badri M, Wood R: Adherence is not a barrier to successful antiretroviral therapy in South Africa. AIDS 2003, 17:1369–1375.

    Article  PubMed  Google Scholar 

  6. Brigido LF, Rodrigues R, Casseb J, et al.: Impact of adherence to antiretroviral therapy in HIV-1-infected patients at a university public service in Brazil. AIDS Patient Care STDS 2001, 15:587–593.

    Article  PubMed  CAS  Google Scholar 

  7. Harries AD, Nyangulu DS, Hargreaves NJ, et al.: Preventing antiretroviral anarchy in Africa. Lancet 2001, 358:410–414.

    Article  PubMed  CAS  Google Scholar 

  8. Attaran A, Freedburg KA, Hirsch M: Dead wrong on AIDS. Washington Post. June 15, 2001; Op-Ed section:A33.

  9. Popp D, Fisher JD: First, do no harm: a call for emphasizing adherence and HIV prevention interventions in active antiretroviral therapy program in the developing world. AIDS 2002, 16:676–678.

    Article  PubMed  Google Scholar 

  10. PetrellaP, Brenner B, Loemba H, Wainberg MA: HIV drug resistance and implications for the introduction of antiretroviral therapy in resource-poor countries. Drug Resist Updat 2001, 4:339–346. This review paper examines the impact of structured antiretroviral delivery and adherence on viral resistance.

    Article  PubMed  CAS  Google Scholar 

  11. Nkengasong JN, Adje-Toure C, Weidle PJ: HIV antiretroviral drug resistance in Africa. AIDS Rev 2004, 6:4–12.

    PubMed  Google Scholar 

  12. OyugiJH, Byakika-Tusiime J, Charlebois ED, et al.: Multiple validated measures of adherence indicate high levels of adherence to generic HIV antiretroviral therapy in a resource-limited setting. J Acquir Immune Defic Syndr 2004, 36:1100–1102. A short-term study that validates methods of measuring adherence to antiretroviral therapy.

    Article  PubMed  CAS  Google Scholar 

  13. Lanièce I, Ciss M, Desclaux A, et al.: Adherence to HAART and its principle determinants in a cohort of Senegalese adults. AIDS 2003, 17:S103-S107.

    Article  PubMed  Google Scholar 

  14. Coetzee D, Boulle A, Hildebrand K, et al.: Promoting adherence to antiretroviral therapy: the experience from a primary care setting in Khayelitsha, South Africa. AIDS 2004, 18(Suppl3):S27-S31.

    Article  PubMed  Google Scholar 

  15. Djomand G, Roels T, Ellerbrock T, et al.: AIDS 2003, 17(Suppl 3):S5-S15.

    Article  PubMed  Google Scholar 

  16. Harries AD, Gomani P, Teck R, et al.: Monitoring the response to antiretroviral therapy in resource poor settings: the Malawi model. Trans R Soc Trop Med Hyg 2004, 98:695–701.

    Article  PubMed  Google Scholar 

  17. Remien RH, Bastos FI, Berkman A, et al.: Universal access to antiretroviral therapy may be the best approach to "Do no harm" in developing countries: the Brazilian experience. AIDS 2003, 17:786–787.

    Article  PubMed  Google Scholar 

  18. Koenig SP, Leandre F, Farmer P: Scaling-up HIV treatment programs in resource-limited settings: the Haiti experience. AIDS 2004, 18(Suppl3):S21-S25.

    Article  PubMed  Google Scholar 

  19. Hacker M, Petersen ML, Enquirez M, Bastos FI: Highly active antiretroviral therapy in Brazil: the challenge of universal access in a context of social inequality. Pan AM J Public Health 2004, 16:78–83.

    Google Scholar 

  20. Byakika-Tusiime JB, Oyugi Tumwikirize WA, Katabira ET, et al.: Adherence to HIV antiretroviral therapy in HIV+ Ugandan patients purchasing therapy. Int J STD AIDS 2005, 16:38–41.

    Article  PubMed  CAS  Google Scholar 

  21. Nachega J, Stein DM, Lehman DA, et al.: Adherence to antiretroviral therapy in HIV-infected adults in Soweto, South Africa. AIDS Res Hum Retroviruses 2004, 20:1053–1057.

    Article  PubMed  CAS  Google Scholar 

  22. Laurent C, Kouanfak C, Koulla-Shiro S, et al.: Effectiveness and safety of a generic fixed dose combination of nevirapine, stavudine and lamivudine in HIV-1 infected adults in Cameroon: open-label, multicentre trial. Lancet 2004, 364:29–34.

    Article  PubMed  CAS  Google Scholar 

  23. Laurent C, Diakhate N, Fatou Ngom Gueye N, et al.: The Senegalese government’s highly active antiretroviral therapy initiative: an 18 month follow-up study. AIDS 2002, 16:1363–1370.

    Article  PubMed  Google Scholar 

  24. Orrell C, Badri M, Wood R: Measuring adherence in a community setting: which measure most valuable? [abstract WePEB5787]. Paper present at the XV International AIDS Conference. Bangkok, Thailand; July 11–16, 2004.

  25. Michaels D: Adherence data from MSF, Khayelitsha [abstract]. Paper presented at the Second South African AIDS Conference. Durban, Kwazulu-Natal; June 7–10, 2005.

  26. Weiser S, Wolfe W, Bangsberg D, et al.: Barriers to adherence for patients living with HIV infection and AIDS in Botswana. J Acquir Immune Defic Syndr 2003, 34:281–288.

    Article  PubMed  Google Scholar 

  27. Weidle PJ, Malamba S, Mwebaze R: Assessment of a pilot anti-retroviral drug therapy program in Uganda: patient’s response, survival, and drug resistance. Lancet 2002, 360:34–40.

    Article  PubMed  CAS  Google Scholar 

  28. Landman R, Schiemann R, Thiam S, et al.: Once-a-day highly active antiretroviral therapy in treatment-naïve adults in Senegal. AIDS 2003, 17:1013–1022.

    Article  Google Scholar 

  29. Baleta A: South Africa approves plan for universal access to antiretrovirals. Lancet 2003, 362:1811.

    Article  PubMed  Google Scholar 

  30. Frick PA, Mandaliya K, Kreiss JK: Impact of an alarm device on medication compliance in women in Mombasa, Kenya. IntJ STD AIDS 2001, 12:329–333.

    Article  CAS  Google Scholar 

  31. Eley B, Nuttall J, Davies M-A, et al.: Initial experience of a public sector antiretroviral treatment program for HIV-infected children and their infected parents. S Afr Med J 2004, 94:643–646.

    PubMed  Google Scholar 

  32. Laurent C, Ngom Gueye NF, Tidiane Ndour C, et al.: Long-term benefits of highly active antiretroviral therapy in Senegalese HIV-1 infected adults. J Acquir Immune Defic Syndr 2005, 38:14–17. An African government program that shows excellent adherence and virologic outcomes maintained over 3 years.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Desmond Tutu HIV Centre, IIDMM, Werner Beit Building-North, Medical School, Anzio Road, Observatory, 7925, Cape Town, South Africa

    Catherine Orrell MBChB, MSc(Med)

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  1. Catherine Orrell MBChB, MSc(Med)
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Orrell, C. Antiretroviral adherence in a resource-poor setting. Curr HIV/AIDS Rep 2, 171–176 (2005). https://doi.org/10.1007/s11904-005-0012-8

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  • DOI: https://doi.org/10.1007/s11904-005-0012-8

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