Adherence to HAART and its principal determinants in a cohort of Senegalese adults.
BACKGROUND
Access to programmes providing highly active antiretroviral therapy (HAART) is recent in Africa. In Senegal, a national initiative was launched in 1998. The capacity of African patients to adhere to complex antiretroviral treatments (ARV) is largely unknown.


METHODS
We assessed adherence and identified the main reasons for treatment interruption in a prospective observational cohort of patients participating in an ARV access programme in Dakar, Senegal. Adherence was estimated each month on the basis of the patients' stated consumption and on the proportion of the prescribed dose returned unused to the dispensing pharmacy. A total of 158 patients were studied between November 1999 and October 2001.


RESULTS
A cross-section analysis showed that the stated level of adherence was high: on average, over the study period, the patients said they had taken 91% of each monthly dose and that they had taken the full monthly dose during two-thirds of the months studied. Adherence tended to be better among patients who were required to make little or no contribution to the cost of their treatment, through an appropriate pricing structure. Adherence was also better with efavirenz-containing regimens than with indinavir-containing regimens.


CONCLUSIONS
These results show that adherence to HAART can be as high in Africa as that generally observed in industrialized countries, and that the cost and type of drug regimen must be taken into account when designing ARV access programmes for poor communities.
Lanièce
Isabelle
I
French Cooperation and National AIDS Program, Dakar, Senegal.
Ciss
Mounirou
M
Desclaux
Alice
A
Diop
Karim
K
Mbodj
Fatou
F
Ndiaye
Barra
B
Sylla
Omar
O
Delaporte
Eric
E
Ndoye
Ibrahima
I
D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D023241:Antiretroviral Therapy, Highly Active / Q000191:economics / Q000523:psychology*; D003430:Cross-Sectional Studies; D003906:Developing Countries; D016527:Drug Costs; D005260:Female; D006078:Government Programs; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology / Q000821:virology; D006801:Humans; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D012051:Reimbursement Mechanisms; D012675:Senegal
D019380:Anti-HIV Agents