Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea

• Published in: PloS one 2015-08, Vol.10 (8), p.e0134918-e0134918
• Main Authors: Gare, Janet, Kelly-Hanku, Angela, Ryan, Claire E, David, Matthew, Kaima, Petronia, Imara, Ulato, Lote, Namarola, Crowe, Suzanne M, Hearps, Anna C
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adhesion; Adult; AIDS; Altitude; Analysis; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Bivariate analysis; Care and treatment; CD4 Lymphocyte Count; Cross-Sectional Studies; Demographics; Disease transmission; Drug resistance; Epidemics - prevention & control; Female; Geography; Health aspects; Health Knowledge, Attitudes, Practice; Highlands; Highly active antiretroviral therapy; HIV; HIV - drug effects; HIV - physiology; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - virology; HIV patients; Human immunodeficiency virus; Humans; Male; Medication Adherence - statistics & numerical data; Middle Aged; Outcome Assessment (Health Care) - methods; Outcome Assessment (Health Care) - statistics & numerical data; Papua New Guinea - epidemiology; Patient compliance; Patient outcomes; Population studies; Risk factors; Sexually transmitted diseases; Socioeconomic Factors; STD; Surveys and Questionnaires; Viral Load - drug effects
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0134918

Adherence to antiretroviral therapy (ART) is paramount for virological suppression and positive treatment outcomes. ART has been rapidly scaled up in Papua New Guinea (PNG) in recent years, however clinical monitoring of HIV+ individuals on ART is limited. A cross-sectional study was conducted at two major sexual health clinics in high HIV prevalence provinces in the Highlands Region of PNG to assess ART adherence, factors affecting adherence and the relationship between ART adherence and virological outcomes. Ninety-five HIV+ individuals were recruited and administered a questionnaire to gather demographic and ART adherence information whilst clinical data and pill counts were extracted from patient charts and blood was collected for viral load testing. Bivariate analysis was performed to identify independent predictors of ART adherence. Fourteen percent (n = 12) of participants showed evidence of virological failure. Although the majority of participants self-reported excellent ART adherence in the last seven days (78.9%, 75/91), pill count measurements indicated only 40% (34/84) with >95% adherence in the last month. Taking other medications while on ART (p = 0.01) and taking ART for ≥1 year (p = 0.037) were positively associated with adherence by self-report and pill count, respectively. Participants who had never heard of drug resistance were more likely to show virological failure (p = 0.033). Misconception on routes of HIV transmission still persists in the studied population. These findings indicate that non-adherence to ART is high in this region of PNG and continued education and strategies to improve adherence are required to ensure the efficacy of ART and prevent HIV drug resistance.