Impact of Highly Active Antiretroviral Therapy Regimens on Adherence Among HIV�infected attending an HIV�Clinic in a Public Setting in South Africa

KATENDE KYENDA NL; Apalata T

Volume : VI, Issue : XII, December - 2016

Impact of Highly Active Antiretroviral Therapy Regimens on Adherence Among HIV�infected attending an HIV�Clinic in a Public Setting in South Africa

Katende Kyenda Nl, Apalata T

Abstract :

Highly Active Antiretroviral Therapy regimens especially the three–drug regimens that include Protease Inhibitors in combination with nucleoside analogues produce a greatly increased level and long–term suppression of HIV–replication, thus reducing morbidity and mortality associated with the infection. The aim of this study was to determine the impact of ARV–regimens on adherence among HIV–infected attending a primary health care centre in Mthatha, Eastern Cape, South Africa. Data were collected from 86 HIV–infected during a descriptivecross–sectional study using a standardized–questionnaire and face–to–face–exit interviews. Pill–counts technique was performed and adherence–rate of ≥95% considered acceptable. Data were analyzed using SPSS 22.0. Univariate–factors associated with poor–adherence to HAART were assessed using ANOVA and p≤0.05 considered statistically significant. Of 86 HIV–infected patients, 73.3% were females and 26.7% males with mean age (±SD) of 35.6 (±9.6) years and were enrolled on HAART for 35.5 (±31.8) months. Adherence–rates computed from 32 patients revealed 71.9% having poor adherence–rate. The mean CD4–count at the initiation of HAART was 232.4 (±169.2) cells/mm3, while the latest was 433.7 (±242.9) cells/mm3. Thirty–two (37.2%) patients on Lamivudine, Tenofovir and Efavirenz (regimen 1A–TDF) and 24 (75%) had poor adherence–rate. The commonest adverse effects experienced by patients on regimen 1A–TDF and TDF, Emtricitabine and Efavirenz (regimen FDC) were CNS–related (35.3%) followed by ENT (23.3%). Evaluated variables associated with poor–adherence to HAART were: salary ≥ R2000 (χ2=4.3, p=0.043); WHO–staging 2 and 3 (χ2=12.09,p=0.007) and total number of other tablets (≥4 combined tablets) (χ2 =10.81,p=0.029). Despite an observed overall improvement of patients’ immune response following HAART, poor–adherence remains a major challenge due to ADEs associated with regimen 1A–TDF, FDC and burden of ≥4 combined tablets.