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14th International AIDS ConferenceBarcelona, Spain — July 7-12, 2002 |
Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. MoOrC1103
BACKGROUND: Adherence to long term treatment presents many challenges to people living with HIV, particularly in poor environments with much stigma. TB preventive therapy (TBPT) is advocated for individuals living with HIV in high TB incidence areas. Implementation has been difficult to achieve and adherence to treatment is poor. In an operational study of 1142 individuals commenced on TBPT in Lusaka, adherence was only 23.5% despite positive feedback from both clients and counsellors. We conducted a series of studies to evaluate reasons for poor adherence to TBPT in Lusaka, Zambia.
METHODS: Focus group discussions were held with PLWHA who had taken TBPT. Subsequently a case control study was conducted and a model of adherence was developed and tested by a prospective cohort study.
RESULTS: Important issues emerging from the focus groups were that of hunger and the perception of side effects. The role of stigma was also elaborated. The case control study confirmed that non-disclosure of HIV status is associated with non-adherence (Adjusted OR 0.13 (95%CI 0.15-0.69) as is a lack of belief in the effect of IPT (Adj OR 0.08 (0.01-0.58). In the prospective cohort study factors significantly associated with adherence were attending VCT on the advice of family or friends and belief that one has a high risk of TB. Our model of adherence demonstrated that health beliefs best predicted adherence (Adj OR 1.8 (0.02-3.71) but that many factors played a role.
CONCLUSIONS: In a poor community there are many obstacles to adherence. Social problems such as hunger may play an important role in non-adherence. Non-disclosure of HIV status and stigma affect adherence to TBPT but may also have important implications for HIV control and for the advent of ARVs into this setting.
Presenting author: Helen Ayles
1Zambart Project, 3, Purves Road, Kensal Green, London, Zambia.
2London School of Hygiene and Tropical medicine, London, United Kingdom.
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MoOrC1103
Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.
