title: Patient retention and adherence to antiretrovirals in a large antiretroviral therapy program in Nigeria: a longitudinal analysis for risk factors.
abstract: BACKGROUND
  Substantial resources and patient commitment are required to successfully scale-up antiretroviral therapy (ART) and provide appropriate HIV management in resource-limited settings. We used pharmacy refill records to evaluate risk factors for loss to follow-up (LTFU) and non-adherence to ART in a large treatment cohort in Nigeria.
  
  
  RESULTS
  We reviewed clinic records of adult patients initiating ART between March 2005 and July 2006 at five health facilities. Patients were classified as LTFU if they did not return >60 days from their expected visit. Pharmacy refill rates were calculated and used to assess non-adherence. We identified risk factors associated with LTFU and non-adherence using Cox and Generalized Estimating Equation (GEE) regressions, respectively. Of 5,760 patients initiating ART, 26% were LTFU. Female gender (p < 0.001), post-secondary education (p = 0.03), and initiating treatment with zidovudine-containing (p = 0.004) or tenofovir-containing (p = 0.05) regimens were associated with decreased risk of LTFU, while patients with only primary education (p = 0.02) and those with baseline CD4 counts (cell/ml(3)) >350 and <100 were at a higher risk of LTFU compared to patients with baseline CD4 counts of 100-200. The adjusted GEE analysis showed that patients aged <35 years (p = 0.005), who traveled for >2 hours to the clinic (p = 0.03), had total ART duration of >6 months (p<0.001), and CD4 counts >200 at ART initiation were at a higher risk of non-adherence. Patients who disclosed their HIV status to spouse/family (p = 0.01) and were treated with tenofovir-containing regimens (p < or = 0.001) were more likely to be adherent.
  
  
  CONCLUSIONS
  These findings formed the basis for implementing multiple pre-treatment visit preparation that promote disclosure and active community outreaching to support retention and adherence. Expansion of treatment access points of care to communities to diminish travel time may have a positive impact on adherence.
authors.affiliation: Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, United States of America. mcharurat@ihv.umaryland.edu
authors.forename: Man
authors.initials: M
authors.lastname: Charurat
authors.forename: Modupe
authors.initials: M
authors.lastname: Oyegunle
authors.forename: Renata
authors.initials: R
authors.lastname: Benjamin
authors.forename: Abdulrazaq
authors.initials: A
authors.lastname: Habib
authors.forename: Emeka
authors.initials: E
authors.lastname: Eze
authors.forename: Prince
authors.initials: P
authors.lastname: Ele
authors.forename: Iquo
authors.initials: I
authors.lastname: Ibanga
authors.forename: Samuel
authors.initials: S
authors.lastname: Ajayi
authors.forename: Maria
authors.initials: M
authors.lastname: Eng
authors.forename: Prosanta
authors.initials: P
authors.lastname: Mondal
authors.forename: Usman
authors.initials: U
authors.lastname: Gebi
authors.forename: Emilia
authors.initials: E
authors.lastname: Iwu
authors.forename: Mary-Ann
authors.initials: MA
authors.lastname: Etiebet
authors.forename: Alash'le
authors.initials: A
authors.lastname: Abimiku
authors.forename: Patrick
authors.initials: P
authors.lastname: Dakum
authors.forename: John
authors.initials: J
authors.lastname: Farley
authors.forename: William
authors.initials: W
authors.lastname: Blattner
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D005260:Female; D005500:Follow-Up Studies; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D009549:Nigeria; D010349:Patient Compliance; D010594:Pharmacies; D016016:Proportional Hazards Models; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors
chemical_list: D044966:Anti-Retroviral Agents