15th International AIDS Conference Bangkok, Thailand - July 11-16, 2004

Int Conf AIDS 2004 Jul 11-16; 15:(abstract no. WeOrB1320)

Desclaux A, Laniece I, Diop K, Sow K, Ciss M, Ndiaye B, Ndoye I
French Cooperation/Multisectorial Aids Control Program, Dakar, Senegal

BACKGROUND: To assess long term adherence to antiretroviral therapies (ART) and its main determinants in a prospective cohort followed in an African context.

METHODS: 167 adults receiving ART within the Senegalese National Program were followed over four years. At least every two months, the pharmacist recorded the quantity of drugs stated as taken over the last 30 days.

RESULTS: Among the 167 eligible subjects, 159 (95%) participated. Twenty of them (13%) died and 8 (5%) withdrew over the 6049 patient-months of observation. Adherence was assessed for 4585 patient-months. A mean monthly adherence level of 95% or above was considered as "high adherence". Logistic regression taking into account the correlated structure of data (GEE population-average model) was used for analysis. Univariate analysis estimated the probability of being highly adherent over the four-year study period as 0.78 with 95% CI [0.74-0.81]. Multivariate analysis suggested that the main factors associated with low adherence were: 1. a symptomatic disease (CDC stages B or C) at the treatment's initiation: OR=0.30; 95% CI [0.20-0.71]; p=0.003 2. the treatment duration: setting the baseline as the first 12 months, the adherence seemed to decrease progressively during M13-M24 (OR=0.54; 95% CI [0.43-0.68]; p=0.000), M25-M36 (OR=0.43; 95% CI [0.32-0.57]; p=0.000) and beyond M37 (OR=0.34; 95% CI [0.23-0.48]; p=0.000) 3. a monthly cost of ART greater than 18 US$: OR=0.61; 95% CI [0.45-0.82]; p=0.001 4. a combination containing a protease inhibitor: OR=0.70; 95% CI [0.47-0.95]; p=0.08.

CONCLUSIONS: Adherence to ART in this African setting was sustained at a high level. However, special measures are recommended to reinforce adherence in such context: encouraging early treatment initiation, implementing adherence support measures over treatment duration, setting acceptable pricing scales (free treatment recommended) and proposing simple and well tolerated combinations as first line regimen.

040711
WeOrB1320

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