title: Adherence to antiretroviral therapy in a home-based AIDS care programme in rural Uganda.
abstract: BACKGROUND
  Poverty and limited health services in rural Africa present barriers to adherence to antiretroviral therapy that necessitate innovative options other than facility-based methods for delivery and monitoring of such therapy. We assessed adherence to antiretroviral therapy in a cohort of HIV-infected people in a home-based AIDS care programme that provides the therapy and other AIDS care, prevention, and support services in rural Uganda.
  
  
  METHODS
  HIV-infected individuals with advanced HIV disease or a CD4-cell count of less than 250 cells per muL were eligible for antiretroviral therapy. Adherence interventions included group education, personal adherence plans developed with trained counsellors, a medicine companion, and weekly home delivery of antiretroviral therapy by trained lay field officers. We analysed factors associated with pill count adherence (PCA) of less than 95%, medication possession ratio (MPR) of less than 95%, and HIV viral load of 1000 copies per mL or more at 6 months (second quarter) and 12 months (fourth quarter) of follow-up.
  
  
  RESULTS
  987 adults who had received no previous antiretroviral therapy (median CD4-cell count 124 cells per muL, median viral load 217,000 copies per mL) were enrolled between July, 2003, and May, 2004. PCA of less than 95% was calculated for 0.7-2.6% of participants in any quarter and MPR of less than 95% for 3.3-11.1%. Viral load was below 1000 copies per mL for 894 (98%) of 913 participants in the second quarter and for 860 (96%) of 894 of participants in the fourth quarter. In separate multivariate models, viral load of at least 1000 copies per mL was associated with both PCA below 95% (second quarter odds ratio 10.6 [95% CI 2.45-45.7]; fourth quarter 14.5 [2.51-83.6]) and MPR less than 95% (second quarter 9.44 [3.40-26.2]; fourth quarter 10.5 [4.22-25.9]).
  
  
  CONCLUSIONS
  Good adherence and response to antiretroviral therapy can be achieved in a home-based AIDS care programme in a resource-limited rural African setting. Health-care systems must continue to implement, evaluate, and modify interventions to overcome barriers to comprehensive AIDS care programmes, especially the barriers to adherence with antiretroviral therapy.
authors.affiliation: Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. pweidle@cdc.gov
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Weidle
authors.forename: Nafuna
authors.initials: N
authors.lastname: Wamai
authors.forename: Peter
authors.initials: P
authors.lastname: Solberg
authors.forename: Cheryl
authors.initials: C
authors.lastname: Liechty
authors.forename: Sam
authors.initials: S
authors.lastname: Sendagala
authors.forename: Willy
authors.initials: W
authors.lastname: Were
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mermin
authors.forename: Kate
authors.initials: K
authors.lastname: Buchacz
authors.forename: Prosper
authors.initials: P
authors.lastname: Behumbiize
authors.forename: Ray L
authors.initials: RL
authors.lastname: Ransom
authors.forename: Rebecca
authors.initials: R
authors.lastname: Bunnell
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D006699:Home Care Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D010349:Patient Compliance; D012424:Rural Population; D014454:Uganda
chemical_list: D044966:Anti-Retroviral Agents