[1118] DETERMINANTS OF ADHERENCE AMONG ADULTS RECEIVING ANTIRETROVIRAL DRUGS IN SENEGAL (ANRS 1215 COHORT STUDY)

2nd International AIDS Society Conference on HIV Pathogenesis and Treatment

Paris, France - July 13 - 16, 2003

[TITLE:] DETERMINANTS OF ADHERENCE AMONG ADULTS RECEIVING ANTIRETROVIRAL DRUGS IN SENEGAL (ANRS 1215 COHORT STUDY)

[AUTHOR(S):] I Laniece¹, K Diop², A Desclaux³, K Sow⁴, M Ciss⁵, B Ndiaye² and I Ndoye⁶
¹French Cooperation/Multisectorial Aids Control Program, Dakar, Senegal; ²Central Pharmacy of Fann Hospital, Dakar, Senegal; ³Laboratory of Human Ecology and Anthropology, Aix-Marseille 3 University, Aix en Provence, France; ⁴Aids Control Division, Ministry of Health, Dakar, Senegal; ⁵National Laboratory of Drugs Control, Dakar, Senegal; and ⁶Multisectorial Aids Control Program, Dakar, Senegal

IAS Conf HIV Pathog Treat 2003 Jul 13-16;2nd: Abstract No. 1118
Antiviral Therapy 2003; 8(Suppl. 1):S501-S502

[ABSTRACT:] Adherence and its main determinants were assessed among a prospective cohort of 159 adults receiving antiretroviral drugs in the Senegalese National Program during 3 years of follow-up, from November 1999 to October 2002. The pharmacist recorded at least every 2 months the quantity of drugs stated as taken over the last 30 days and the proportion of the prescribed dose returned unused. 159 among the 167 eligible patients (95%) participated. Of them, 17 died and three withdrew over the study period, which cumulated 4,451 patients-months of observation. Adherence data were collected for 3,583 patients-months (80.4%). Intent-to-treat antiretroviral combinations consisted of dual therapies (4%), three-drug therapies containing a protease inhibitor (43%) or a non-nucleoside inhibitor (53%) of the reverse transcriptase. ‘High adherence’ was defined as a mean monthly adherence level of 95% or above. The probability of being highly adherent was 0.80 with 95% CI: 0.77–0.83. A multivariate analysis using logistic regression taking into account the correlated structure of data (GEE population-average model) suggested that the proportion of highly adherent patients decreased with: 1) a treatment duration of more than 12 months (OR=0.62; 95% CI: 0.49–0.79; P=0.000); 2) a monthly cost of treatment greater than 15 euros (OR=0.73; 95% CI: 0.54–0.99; P=0.041); 3) a regimen containing protease inhibitor among the 150 patients at CDC disease stages B or C at inclusion (OR=0.61; 95% CI: 0.39–0.96; P=0.03). Adherence to antiretrovirals may be reinforced in this African setting by proposing appropriate regimen (affordable, well tolerated, simple) and adherence supporting measures over treatment duration (such as discussion groups and/or individual counselling and/or home visits involving health/social workers and PlWA).

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