AEGiS-13IAC: Observance of anti-retroviral therapy in the Senegalese governmental initiative.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

Observance of anti-retroviral therapy in the Senegalese governmental initiative.

Int Conf AIDS 2000 Jul 9-14; 13:21 (abstract no.. LbOr20)

Laniece I, Ciss M, Djeme B, Ndoye I
Cooperation Francaise, Programme National de Lutte contre le SIDA, Dkara Medina, Senegal. Fax: +221 822 15 07, E-mail: laniecebissao@metissacana.sn.

ISSUES: There have been debates about the ability of African patients to reach a high level of observance. In the Senegalese Initiative, a research study (PNLS/ANRS/IMEA) assessed the adherence to anti-retroviral treatment over a 6 months period.

DESCRIPTION: 99 patients filling their monthly anti-retroviral prescription had an interview with the pharmacist who delivers the drugs, describing the way they had taken their doses during the past month.

RESULTS: The study period cumulated 470 months of follow-up. The patients had completed 1 to 20 months of treatment. Observance was estimated at least once for each patient and overall on 89% of months of follow-up. Main findings are :- a mean observance of 83%.-a lower adherence for tritherapies including a protease inhibitor (p<10-5). Mean observance estimates were: 98% among the 11 patients receiving 2 nucleosidic reverse transcriptase inhibitors (2 NUC), 97% among the 34 ones receiving 2 NUC plus efavirenz (EFZ) and 77% among the 54 ones receiving 2 NUC indinavir (IDV). After excluding treatment interruptions for economic reasons, mean adherences were closer: 98% for bitherapies and tritherapies with EFZ versus 84% for tritherapies with IDV. - a lower observance among patients paying for drugs. Among the 54 patients receiving tritherapy with IDV, mean observance was 95% when the drugs are free (8 patients; it was 74% among the 46 patients paying for it (p=0.18. - reasons for observance inferior to 80% (19% of the 388 months of follow-up) were mainly economic (50% of the episods) and medical (36%).- observance between 80% and 100% was related mainly to travels (29%), side effects or other illnesses (24%).

CONCLUSION: A high level of adherence may be reached for anti-retroviral treatments in an African country. Adherence may be enhanced by once or twice a day regimens and by drugs better tolerated than IDV. The cost of drugs remains the main cause of poor observance.

Keywords: AEGIS, Indinavir, Reverse Transcriptase Inhibitors, Antiretroviral Therapy, Highly Active, Retroviridae, HIV-1, Oxazines, Drug Therapy, Combination, efavirenz, Human, therapy, drug therapy, AIDS
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