Patient retention and adherence to antiretrovirals in a large antiretroviral therapy program in Nigeria: a longitudinal analysis for risk factors

• Published in: PloS one 2010-05, Vol.5 (5), p.e10584-e10584
• Main Authors: Charurat, Man, Oyegunle, Modupe, Benjamin, Renata, Habib, Abdulrazaq, Eze, Emeka, Ele, Prince, Ibanga, Iquo, Ajayi, Samuel, Eng, Maria, Mondal, Prosanta, Gebi, Usman, Iwu, Emilia, Etiebet, Mary-Ann, Abimiku, Alash'le, Dakum, Patrick, Farley, John, Blattner, William
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adhesion; Adult; AIDS; Anti-Retroviral Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Antiviral agents; CD4 antigen; Drugstores; Education; Evidence-Based Healthcare/Health Services Research and Economics; Evidence-based medicine; Female; Follow-Up Studies; Health care facilities; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; Human immunodeficiency virus; Humans; Infectious Diseases/HIV Infection and AIDS; Longitudinal Studies; Male; Medical research; Medical schools; Medication Adherence; Nigeria; Patient Compliance; Patients; Pharmacies; Pharmacy; Proportional Hazards Models; Public Health and Epidemiology/Global Health; Regression Analysis; Resource management; Retention; Risk analysis; Risk Factors; Teaching hospitals; Tenofovir; Therapy; Time Factors; Zidovudine
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0010584

Substantial resources and patient commitment are required to successfully scale-up antiretroviral therapy (ART) and provide appropriate HIV management in resource-limited settings. We used pharmacy refill records to evaluate risk factors for loss to follow-up (LTFU) and non-adherence to ART in a large treatment cohort in Nigeria. We reviewed clinic records of adult patients initiating ART between March 2005 and July 2006 at five health facilities. Patients were classified as LTFU if they did not return >60 days from their expected visit. Pharmacy refill rates were calculated and used to assess non-adherence. We identified risk factors associated with LTFU and non-adherence using Cox and Generalized Estimating Equation (GEE) regressions, respectively. Of 5,760 patients initiating ART, 26% were LTFU. Female gender (p < 0.001), post-secondary education (p = 0.03), and initiating treatment with zidovudine-containing (p = 0.004) or tenofovir-containing (p = 0.05) regimens were associated with decreased risk of LTFU, while patients with only primary education (p = 0.02) and those with baseline CD4 counts (cell/ml(3)) >350 and 6 months (p200 at ART initiation were at a higher risk of non-adherence. Patients who disclosed their HIV status to spouse/family (p = 0.01) and were treated with tenofovir-containing regimens (p < or = 0.001) were more likely to be adherent. These findings formed the basis for implementing multiple pre-treatment visit preparation that promote disclosure and active community outreaching to support retention and adherence. Expansion of treatment access points of care to communities to diminish travel time may have a positive impact on adherence.