AEGiS-15IAC: Factors associated with antiretroviral adherence in public clinics in Rio de Janeiro, Brazil.

15th International AIDS Conference

Bangkok, Thailand - July 11-16, 2004

Factors associated with antiretroviral adherence in public clinics in Rio de Janeiro, Brazil.

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrB1319)

Hofer CB, Schechter M, Harrison LH
HUCFF Universidade Federal do Rio de Janeiro -Brazil

BACKGROUND: Lack of adherence is a major cause of antiretroviral therapy (ART) failure. The objective of this study was to describe the ART adherence rate in the public health system in Rio de Janeiro, where patients receive ART free of charge, and to identify causes associated with lack of adherence.

METHODS: Patients over 18 years old and on ART for at least six months in 5 public clinics in Rio de Janeiro, were included. Adherence was measured by self-report (number of missed doses of ART in 3 days prior to the interview) and validated by comparison with the Morisk criteria and missed appointments. Afterwards, physicians were interviewed about the perceived adherence of their patients. Adherence was categorized as either taking ≥95% of the ARTs prescribed 3 days prior to the interview (adherent), or<95% (non-adherent). Variables related to demographics, personal lifestyles, and treatment were evaluated and the variables with p-value<0.15 were selected for a logistic regression analysis.

RESULTS: 220 patients were interviewed. The mean self-reported adherence (number of prescribed doses taking in the 3 days before the interview) was 81%, and the mean perceived adherence by the doctors was 75%. 116 patients were classified as non-adherent and 104 as adherent. Variables associated with lack of adherence were: family problems causing difficulties in taking ART (OR=3.0, p=0.02); years known to be HIV positive (OR=1.02 per year, p=0.05); patient asks physician about drug interactions (OR=0.2, p=<0.01); knows names and/or recognizes picture of ART (OR=0.39, p=0.03); belief that ART would make them sick (OR=3.2, p=0.03); financial problems (OR=1.8, p=0.07); doctor taught how to take ART (OR=2.8, p=0.01); number of times that patient takes ART per 24h (OR=1.6 per time, p=0.02).

CONCLUSIONS: The adherence in the public clinics in Rio de Janeiro was similar to that observed in developed countries. However variables associated with personal problems, the patient-physician relationship, and lack of knowledge about ART were associated with lack of adherence.

Keywords: AEGIS, HIV Seropositivity, Ambulatory Care Facilities, Interviews, Brazil, Humans

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WeOrB1319