The mean levels of adherence and factors contributing to non-adherence in patients on highly active antiretroviral therapy.

OBJECTIVE To determine the mean level of adherence and factors contributing to non-adherence in patients on Highly Active Antiretroviral Therapy (HAART). METHODS An observational study was done on 101 HIV/AIDS patients attending the Centre for HIV/ AIDS Research, Education and Services (CHARES) - University Hospital of the West Indies, between May 2006 and August 2006. A questionnaire was administered asking questions re: prescribed and actual dosing frequency and number of antiretroviral tablets for the previous week, reasons for nonadherence, duration of Highly Active Antiretroviral Therapy, age, employment status and level of education. Mean levels of adherence were calculated using self and social worker/nurse reported dosing frequency and number of tablets. Good adherence was defined as 95% or greater. Multiple regression analysis was used to determine factors impacting on adherence. RESULTS Ninety-six patients were included for final analysis. Mean levels of adherence were as follows: 87.66%--self-report for tablets; 88.70%--self-report for dosing frequency; 87.02%--social worker/ nurse report for tablets; 88.10%--social worker/nurse report for dosing frequency. There were significant positive correlations between self and social worker/nurse reports using dosing frequency (Spearman Rho correlation coefficient 0.943, p = 0.01) or number of tablets (Spearman Rho correlation coefficient 0.955, p = 0.01). Adherence to self-reported number of tablets and dosing frequency were 58.4% and 56.4% respectively. Duration of HAART was found to have a significant negative correlation with the level of self-reported adherence to tablets (p = 0.002). CONCLUSION Adherence to HAART is sub-optimum in patients at the CHARES. This must be urgently addressed to prevent the development of resistant HIV strains and treatment failure.