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Study Team

Factors related to non-adherence to antiretroviral (ART) drugs among adult ART clients attending 18 facilities in Tanzania, Uganda and Zambia Julie Denison, FHI360 Olivier Koole, Institute of Tropical Medicine. Study Team. Gideon Kwesigabo Fred Wabwire-Mangen Modest Mulenga Julie Denison

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Study Team

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  1. Factors related to non-adherence to antiretroviral (ART) drugs among adult ART clients attending 18 facilities in Tanzania, Uganda and ZambiaJulie Denison, FHI360Olivier Koole, Institute of Tropical Medicine

  2. Study Team • Gideon Kwesigabo • Fred Wabwire-Mangen • Modest Mulenga • Julie Denison • Sharon Tsui • Cindy Geary • Meng Wang • YaDiulMukadi • Leine Stuart • Eric Van Praag • Kwasi Torpey • JorisMenten • Robert Colebunders • Olivier Koole • David Bangsberg • Andrew Auld • Simon Agolory • Seymour Williams • Jonathan Kaplan • Aaron Zee • FHI 360, USA • MuhimbiliUniversity of Health and Allied Sciences, Tanzania • Infectious Diseases Institute, Makerere University Medical School, Uganda • Tropical Diseases Research Centre, Zambia • Institute of Tropical Medicine, Belgium • Massachusetts General Hospital, USA • Centers for Disease Control and Prevention, USA

  3. Context • Massive ART scale-up: 8 million people on ART • High levels of ART adherence required for viral suppression and good clinical outcomes • Adherence levels higher in sub-Saharan Africa • Mills et al pooled estimate: 55% N. America; 77% SSA (JAMA 2006) • Nachega et al (Curr Opin HIV/AIDS 2010)

  4. Objectives Primary To characterize the current level of adherence among ART clinic patients across multiple program settings Secondary To identify important factors associated with ART adherence, including both individual risk factorsandprogram characteristics

  5. TANZANIA ZAMBIA Study Population and Sites • StudyPopulation • 18+ years at ART initiation at study site • Initiated 3 ARVs at least 6 months prior to data collection • Study sites • 3 countries • 6 sites per country, purposively selected UGANDA

  6. Methods Cross-sectional design: 250 patients per site systematically selected April-August 2011

  7. Methods • Viral load testing conducted at six sites • June to July 2011, Health Care Manager questionnaire conducted at 18 sites • Rural/Urban • Level and type of health facility • Community ART dispensing • ART initiation requirements • Stockouts • Type of clinic staff (i.e. Lay counselors)

  8. Analysis • Adherence levels described with cutoff points determined by ROC curve analysis using HIV viral load (VL) < />=1,000 copies/ml • Optimal adherence measures selected based on degree of association with viral load failure • Multivariate regression analysis, adjusted for site-level clustering, assessed associations between non-adherence and individual and program factors

  9. Patient Accounting

  10. Selected Participant Characteristics

  11. Selected Program Characteristics

  12. 1. Levels of Incomplete Adherence • 9.9% (148/1,496) had VL >1000 copies/ml • VL failure ranged from 7.2%- 17.2% by study site

  13. 1. Levels of Incomplete Adherence

  14. 2. Selection of Adherence Measures: Associations with Viral Load Failure

  15. 2. Selection of Adherence Measures: Associations with Viral Load Failure

  16. 3. Model Building: BivariateIncomplete Adherence Pharmacy MPR

  17. 3. Model Building: BivariateIncomplete Adherence Pharmacy MPR

  18. 3. Model Building: MultivariableIncomplete Adherence Pharmacy MPR

  19. Conclusions • Wide variability in adherence levels • Pharmacy MPR and provider estimates associated with VL failure • Interventions needed to • Reach younger ART clients • Support long-term adherence • Address internalized stigma

  20. Special thanks to our funders, partners, study clinics and ART clients

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