title: Predictors of incomplete adherence, virologic failure, and antiviral drug resistance among HIV-infected adults receiving antiretroviral therapy in Tanzania.
abstract: BACKGROUND
  Access to antiretroviral therapy is rapidly expanding in sub-Saharan Africa. Identifying the predictors of incomplete adherence, virologic failure, and antiviral drug resistance is essential to achieving long-term success.
  
  
  METHODS
  A total of 150 subjects who had received antiretroviral therapy for at least 6 months completed a structured questionnaire and adherence assessment, and plasma human immunodeficiency virus (HIV) RNA levels were measured. Virologic failure was defined as an HIV RNA level >400 copies/mL; for patients with an HIV RNA level >1000 copies/mL, genotypic antiviral drug resistance testing was performed. Predictors were analyzed using bivariable and multivariable logistic regression models.
  
  
  RESULTS
  A total of 23 (16%) of 150 subjects reported incomplete adherence. Sacrificing health care for other necessities (adjusted odds ratio [AOR], 19.8; P<.01) and the proportion of months receiving self-funded treatment (AOR, 23.5; P=.04) were associated with incomplete adherence. Virologic failure was identified in 48 (32%) of 150 subjects and was associated with incomplete adherence (AOR, 3.6; P=.03) and the proportion of months receiving self-funded antiretroviral therapy (AOR, 13.0; P=.02). Disclosure of HIV infection status to family members or others was protective against virologic failure (AOR, 0.10; P=.04).
  
  
  CONCLUSIONS
  Self-funded treatment was associated with incomplete adherence and virologic failure, and disclosure of HIV infection status was protective against virologic failure. Efforts to provide free antiretroviral therapy and to promote social coping may enhance adherence and reduce rates of virologic failure.
authors.affiliation: Kilimanjaro Christian Medical Centre, Tumaini University, Moshi, Tanzania.
authors.forename: Habib O
authors.initials: HO
authors.lastname: Ramadhani
authors.forename: Nathan M
authors.initials: NM
authors.lastname: Thielman
authors.forename: Keren Z
authors.initials: KZ
authors.lastname: Landman
authors.forename: Evaline M
authors.initials: EM
authors.lastname: Ndosi
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Kirchherr
authors.forename: Rekha
authors.initials: R
authors.lastname: Shah
authors.forename: Humphrey J
authors.initials: HJ
authors.lastname: Shao
authors.forename: Susan C
authors.initials: SC
authors.lastname: Morpeth
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: McNeill
authors.forename: John F
authors.initials: JF
authors.lastname: Shao
authors.forename: John A
authors.initials: JA
authors.lastname: Bartlett
authors.forename: John A
authors.initials: JA
authors.lastname: Crump
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000191:economics / Q000627:therapeutic use*; D024921:Drug Resistance, Multiple, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance; D012307:Risk Factors; D012959:Socioeconomic Factors; D013636:Tanzania
chemical_list: D019380:Anti-HIV Agents