title: Adherence to antiretroviral therapy in an urban, free-care HIV clinic in Guatemala City, Guatemala.
abstract: BACKGROUND
  Numerous studies have demonstrated that, in addition to inherent qualities of antiretroviral (ARV) medications, adherence is affected by demographic, socioeconomic, and psychological factors. There are limited data about factors affecting adherence to antiretroviral therapy (ART) among HIV-infected persons in urban Guatemalan HIV care centers.
  
  
  METHODS
  Participants were patients at an urban, free-care public clinic in Guatemala City and obtained medications from a closed-pharmacy system. Nonpregnant patients ≥18 years who received medications from the Global Fund to Fight AIDS, Tuberculosis & Malaria, who had taken ARV medications for ≥12 weeks, who arrived for an appointment at the clinic, and who provided informed consent were interviewed. Adherence was measured using pharmacy pill counts and patient self-reports. Recent biological markers for each patient were collected from the clinic's database, and χ( 2) and descriptive statistics were used to analyze results.
  
  
  RESULTS
  Among 122 patients interviewed, mean adherence by pill count was 97%. A total of 110 patients (90%) had adherence ≥95% using pharmacy pill counts, and 108 (89%) had adherence ≥95% using self-reports. Virologic failure (viral load [VL] ≥500 copies/mL) was significantly less common among patients with ≥95% adherence (P = .02). Family and spousal support for treatment were significantly associated with ≥95% adherence (P = .01 and .003, respectively). The presence of stavudine (d4T) in a patient's regimen was significantly associated with <95% adherence according to self-reports (P < .01). The most common self-reported cause for missing medications was forgetfulness, followed by leaving medications at home. Inability to travel to the clinic was a major cause of missing medications, and only 51 patients (41.8%) reported always having sufficient economic resources to reach the clinic for appointments and to refill prescriptions.
  
  
  CONCLUSIONS
  In this urban Central American population, high levels of adherence were measured by both self-report and pharmacy pill count. Socioeconomic and demographic conditions associated with adherence and specific reasons for missing medications were identified.
authors.affiliation: Princeton University, Princeton, NJ, USA.
authors.forename: Jeffrey I
authors.initials: JI
authors.lastname: Campbell
authors.forename: Ana Lucía
authors.initials: AL
authors.lastname: Ruano
authors.forename: Blanca
authors.initials: B
authors.lastname: Samayoa
authors.forename: Dina Lorena
authors.initials: DL
authors.lastname: Estrado Muy
authors.forename: Eduardo
authors.initials: E
authors.lastname: Arathoon
authors.forename: Benjamin
authors.initials: B
authors.lastname: Young
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D006166:Guatemala; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D012959:Socioeconomic Factors; D014505:Urban Population
chemical_list: D019380:Anti-HIV Agents