AIDS and Behavior

, Volume 22, Issue 5, pp 1671–1678 | Cite as

Patient-Initiated Repackaging of Antiretroviral Therapy, Viral Suppression and Drug Resistance

  • Habib O. Ramadhani
  • Charles Muiruri
  • Venance P. Maro
  • Balthazar Nyombi
  • Michael Omondi
  • Julian B. Mushi
  • Eileen S. Lirhunde
  • John A. Bartlett
Original Paper


Patient-initiated repackaging of antiretroviral therapy (ART) refers to removal of ART medications from their original manufacturer’s containers, and putting them into alternative containers. This behavior may be triggered by stigma associated with HIV infection, and may impact patient outcomes. We assessed association between patient initiated repackaging of ART and failure to achieve viral suppression (FVS) in a sample of 450 HIV-infected adults (≥8 years) on first line ART for ≥6 months. FVS was defined as a plasma HIV RNA level ≥400 copies/mL. A total of 197 (43.7%) patients reported repackaging their ART medications. One hundred ninety-one patients (42.4%) failed to suppress and FVS was associated with medication repackaging [adjusted odds ratio (aOR), 2.2; 95% CI 1.4–3.3.] Adherence to ART was also associated with FVS (aOR; 0.4; 95% CI 0.2–0.6.). Benefits of retaining drugs in their original packaging along with adherence to ART should be emphasized to reduce the risk of FVS.


HIV Repackaging of anti-retro-viral Virological suppression Stigma ART resistance mutations 



We thank the management of the 5 CTCs for invaluable assistance in conducting the study. We also thank study participants and other staff members for their assistance with this study. Moreover, we thank Godfrey Mushi, Gaudensia H. Lyimo and Rita P. Minja for conducting patient interviews and data collection.


This research was funded by the Duke Center For AIDS Research (CFAR), a National Institutes of Health-funded program (Grant Number P30 AI064518-06).

Compliance with Ethical Standards

Conflicts of interest

The authors have no conflicts of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Habib O. Ramadhani
    • 1
    • 2
  • Charles Muiruri
    • 3
  • Venance P. Maro
    • 1
    • 4
  • Balthazar Nyombi
    • 1
    • 2
  • Michael Omondi
    • 3
  • Julian B. Mushi
    • 5
  • Eileen S. Lirhunde
    • 6
  • John A. Bartlett
    • 3
    • 7
  1. 1.Kilimanjaro Christian Medical Centre, (KCMC)MoshiTanzania
  2. 2.Kilimanjaro Christian Medical University CollegeMoshiTanzania
  3. 3.Duke Global Health InstituteDurhamUSA
  4. 4.Mawenzi Regional HospitalMoshiTanzania
  5. 5.Kilema Designated District HospitalMoshiTanzania
  6. 6.Kibosho Designated District HospitalMoshiTanzania
  7. 7.Division of Infectious Diseases and International Health, Department of MedicineDuke University Medical CenterDurhamUSA

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