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1 December 2007

Volume 45, Number 11
Clinical Infectious Diseases 2007;45:1492–1498
© 2007 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2007/4511-0016$15.00
DOI: 10.1086/522991
CSE THEME ARTICLE HIV/AIDS

Predictors of Incomplete Adherence, Virologic Failure, and Antiviral Drug Resistance among HIV‐Infected Adults Receiving Antiretroviral Therapy in Tanzania

Habib O. Ramadhani,1

Nathan M. Thielman,3

Keren Z. Landman,3

Evaline M. Ndosi,1

Feng Gao,4

Jennifer L. Kirchherr,4

Rekha Shah,4

Humphrey J. Shao,1

Susan C. Morpeth,3

Jonathan D. McNeill,3

John F. Shao,1,2

John A. Bartlett,1,2,3 and

John A. Crump1,2,3

1Kilimanjaro Christian Medical Centre and 2Kilimanjaro Christian Medical College, Tumaini University, Moshi, Tanzania; and 3Division of Infectious Diseases and International Health and 4Human Vaccine Institute, Department of Medicine, Duke University Medical Center, Durham, North Carolina

Background.Access to antiretroviral therapy is rapidly expanding in sub‐Saharan Africa. Identifying the predictors of incomplete adherence, virologic failure, and antiviral drug resistance is essential to achieving long‐term success.

Methods.A total of 150 subjects who had received antiretroviral therapy for at least 6 months completed a structured questionnaire and adherence assessment, and plasma human immunodeficiency virus (HIV) RNA levels were measured. Virologic failure was defined as an HIV RNA level >400 copies/mL; for patients with an HIV RNA level >1000 copies/mL, genotypic antiviral drug resistance testing was performed. Predictors were analyzed using bivariable and multivariable logistic regression models.

Results.A total of 23 (16%) of 150 subjects reported incomplete adherence. Sacrificing health care for other necessities (adjusted odds ratio [AOR], 19.8; ) and the proportion of months receiving self‐funded treatment (AOR, 23.5; ) were associated with incomplete adherence. Virologic failure was identified in 48 (32%) of 150 subjects and was associated with incomplete adherence (AOR, 3.6; ) and the proportion of months receiving self‐funded antiretroviral therapy (AOR, 13.0; ). Disclosure of HIV infection status to family members or others was protective against virologic failure (AOR, 0.10; ).

Conclusions.Self‐funded treatment was associated with incomplete adherence and virologic failure, and disclosure of HIV infection status was protective against virologic failure. Efforts to provide free antiretroviral therapy and to promote social coping may enhance adherence and reduce rates of virologic failure.

Received 9 March 2007; accepted 10 May 2007; electronically published 22 October 2007.

Reprints or correspondence: Dr. John A. Crump, Div. of Infectious Diseases and International Health, Dept. of Medicine, Duke University Medical Center, Box 3867, Durham, NC 27710 ().

CSE Global Theme Issue on Poverty and Human Development

Cited by

Leonardo Palombi, Maria Cristina Marazzi, Giovanni Guidotti, Paola Germano, Ersilia Buonomo, Paola Scarcella, Annamaria Doro Altan, Ines Da Vitoria M. Zimba, Massimo Magnano San Lio, and Andrea De Luca, for the DREAM Program. (2009) Incidence and Predictors of Death, Retention, and Switch to Second‐Line Regimens in Antiretroviral‐Treated Patients in Sub‐Saharan African Sites with Comprehensive Monitoring Availability. Clinical Infectious Diseases 48:1, 115-122
Online publication date: 1-Jan-2009.
Abstract-Full Text-PDF Version (314 kB)
Michael J. Stirratt, Christopher M. Gordon. (2008) Adherence to biomedical HIV prevention methods: Considerations drawn from HIV treatment adherence research. Current HIV/AIDS Reports 5:4, 186-192
Online publication date: 1-Dec-2008.
CrossRef
Julian H Elliott, Lut Lynen, Alexandra Calmy, Andrea De Luca, Robert W Shafer, Maria Zolfo, Bonaventura Clotet, Sarah Huffam, Charles AB Boucher, David A Cooper, Jonathan M Schapiro. (2008) Rational use of antiretroviral therapy in low-income and middle-income countries: optimizing regimen sequencing and switching. AIDS 22:16, 2053-2067
Online publication date: 1-Nov-2008.
CrossRef
Avina Sarna, Stanley Luchters, Scott Geibel, Matthew F Chersich, Paul Munyao, Susan Kaai, Kishorchandra N Mandaliya, Khadija S Shikely, Marleen Temmerman, Naomi Rutenberg. (2008) Short- and Long-Term Efficacy of Modified Directly Observed Antiretroviral Treatment in Mombasa, Kenya: A Randomized Trial. JAIDS Journal of Acquired Immune Deficiency Syndromes 48:5, 611-619
Online publication date: 1-Sep-2008.
CrossRef
Timothy P. Flanigan, Kara Wools‐Kaloustain, Joseph Harwell, Susan Cu‐Uvin, Sylvester Kimaiyo, and E. Jane Carter
CSE Poverty and Human Development. (2007) Editorial Commentary: Highly Active Antiretroviral Therapy (HAART)–Plus: Next Steps to Enhance HAART in Resource‐Limited Areas?. Clinical Infectious Diseases 45:11, 1499-1501
Online publication date: 1-Dec-2007.
Citation-Full Text-PDF Version (187 kB)

  • Presented in part: 13th Conference on Retroviruses and Opportunistic Infections, Denver, Colorado, 5–9 February 2006 (abstract 553), and XVI International AIDS Conference, Toronto, Canada, 13–18 August 2006 (abstract ThLb0213).

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