title: Predictors of adherence to antiretroviral therapy in rural Zambia.
abstract: OBJECTIVE
  Antiretroviral therapy (ART) adherence levels of >or=95% optimize outcomes and minimize HIV drug resistance. As such, identifying barriers to adherence is essential. We sought to assess travel to point-of-care for ART as a potential barrier to adherence in rural Zambia, within the context of patient demographics, perceived stigma, and selected clinical indices.
  
  
  METHODS
  We studied 424 patients receiving ART from the Macha Mission Hospital (MMH). Interviews ascertained age, gender, education, perceived stigma, nearest rural health facility (RHF), and mode/cost/time of transport for each study participant. Motorcycle odometer and global positioning system way-points measured distance from the MMH to each of the RHFs, estimating patients' home-to-MMH travel distances. Body mass index, World Health Organization HIV/AIDS stage, and pill counts were assessed from review of patients' medical and pharmacy records.
  
  
  RESULTS
  At least 95% adherence was documented for 83.7% of the patients in their first months of ART. Travel-related factors did not predict adherence. Adherence was higher for those on ART for a longer time (odds ratio = 1.04 per day; P = 0.002).
  
  
  CONCLUSIONS
  Patients in rural Zambia can achieve adherence rates compatible with good clinical outcomes despite long travel distances. The MMH was able to provide quality HIV/AIDS care by implementing programmatic features selecting for a highly adherent population in this resource-limited setting.
authors.affiliation: Institute of Global Health, Departments of Pediatrics and Biostatistics, Vanderbilt University School of Medicine, Nashville, TN 37232-0242, USA. james.g.carlucci@vanderbilt.edu
authors.forename: James G
authors.initials: JG
authors.lastname: Carlucci
authors.forename: Aniset
authors.initials: A
authors.lastname: Kamanga
authors.forename: Robb
authors.initials: R
authors.lastname: Sheneberger
authors.forename: Bryan E
authors.initials: BE
authors.lastname: Shepherd
authors.forename: Cathy A
authors.initials: CA
authors.lastname: Jenkins
authors.forename: John
authors.initials: J
authors.lastname: Spurrier
authors.forename: Sten H
authors.initials: SH
authors.lastname: Vermund
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D012931:Social Environment; D011795:Surveys and Questionnaires; D015024:Zambia
chemical_list: D019380:Anti-HIV Agents