title: Adherence and treatment response among HIV-1-infected adults receiving antiretroviral therapy in a rural government hospital in Southwestern Uganda.
abstract: BACKGROUND
  Large-scale, government-based antiretroviral therapy (ART) programs in rural areas of resource-poor countries remain largely unevaluated.
  
  
  METHODS
  We conducted a retrospective review of all patients receiving ART (n = 399) to assess survival and retention in care and a prospective evaluation of patients on ART for at least 6 months (n = 175). We used 3-day self-report to measure adherence.
  
  
  RESULTS
  The probability (95% confidence interval [CI]) of surviving and remaining in care was 0.76 (0.72, 0.81) at 1 year. Men and patients with advanced disease were more likely to die or be lost to follow-up. At baseline, 149 (85%) reported 100% adherence. Nonadherence was associated with lack of suppression of viral replication (odds ratio [OR] = 4.5; 95% CI: 1.8, 11.5). Missing a scheduled clinic visit and lack of disclosure of HIV status were associated with nonadherence.
  
  
  CONCLUSIONS
  Viral suppression was high, but counseling to include HIV disclosure to family and keeping scheduled clinic appointments may improve long-term adherence and treatment outcomes.
authors.affiliation: Department of Community Health, Mbarara University of Science and Technology, Mbarara, Uganda. fbaj@yahoo.com
authors.forename: Francis
authors.initials: F
authors.lastname: Bajunirwe
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Arts
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Tisch
authors.forename: Charles H
authors.initials: CH
authors.lastname: King
authors.forename: Sara M
authors.initials: SM
authors.lastname: Debanne
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Sethi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D015397:Program Evaluation; D012367:RNA, Viral / Q000097:blood; D012424:Rural Population; D015996:Survival Rate; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral