Evaluation of adherence to highly active antiretroviral therapy in adults in Jamaica.
OBJECTIVE
Highly active antiretroviral therapy (HAART) has improved morbidity and mortality and quality of life, revitalized communities and transformed the perception of HIV/AIDS from being a "death sentence" to a chronic illness. Strict and sustained adherence to medication is essential long-term viral suppression. In April 2005, an Adherence Support Programme was introduced to Jamaica's HIV Programme, whereby Persons Living with HIV/AIDS (PLWHA) who had achieved high levels of adherence were trained to provide support to other PLWHA in order to increase their adherence to HAART regimens.


METHODS
A cross-sectional survey of 116 individuals with advanced HIV and on HAART was performed in June and July 2006.


RESULTS
Many participants were unemployed, poor persons with limited education. Based on self-report of seven-day adherence, 54.8% of persons were 95-100% adherent, 37.5% were 80-94% adherent and 7.7% were < 80% adherent. Having interacted with an adherence counsellor was not associated with adherence levels. Factors associated with nonadherence were: being away from home (38%), sleeping through dose-time (37%), forgetfulness (37%) and running out of pills (31%). Having no food (26.9%), not wanting to be seen taking medication (200%) and intolerable side effects (18.8%) were also reasons given. Only 44% of persons used aids to remind them of dose times.


CONCLUSIONS
Adherence in this study group is low and may have worsened since 2005. More emphasis must be placed on preparing adults to start HAART The use of pillboxes and other reminders such as alarm clocks and cell phones must be reinforced.
Harvey
K M
KM
The National AIDS Programme, Ministry of Health, Kingston, Jamaica. harveyk@moh.gov.jm
Carrington
D
D
Duncan
J
J
Figueroa
J P
JP
Hirschorn
L
L
Manning
D
D
Jackson
S
S
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D007563:Jamaica / Q000453:epidemiology; D008297:Male; D055118:Medication Adherence; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
D019380:Anti-HIV Agents