Adherence and Treatment Response Among HIV-1-Infected Adults Receiving Antiretroviral Therapy in a Rural Government Hospital in Southwestern Uganda

Abstract

Background. Large-scale, government-based antiretroviral therapy (ART) programs in rural areas of resource-poor countries remain largely unevaluated. Methods. We conducted a retrospective review of all patients receiving ART (n ¼ 399) to assess survival and retention in care and a prospective evaluation of patients on ART for at least 6 months (n ¼ 175). We used 3-day self-report to measure adherence. Results. The probability (95% confidence interval [CI]) of surviving and remaining in care was 0.76 (0.72, 0.81) at 1 year. Men and patients with advanced disease were more likely to die or be lost to follow-up. At baseline, 149 (85%) reported 100% adherence. Non-adherence was associated with lack of suppression of viral replication (odds ratio [OR] ¼ 4.5; 95% CI: 1.8, 11.5). Missing a scheduled clinic visits and lack of disclosure of HIV status were associated with non-adherence. Conclusion. Viral suppression was high, but counseling to include HIV disclosure to family and keeping scheduled clinic appointments may improve long-term adherence and treatment outcomes