title: Adherence and virologic suppression during the first 24 weeks on antiretroviral therapy among women in Johannesburg, South Africa - a prospective cohort study.
abstract: BACKGROUND
  Adherence is a necessary part of successful antiretroviral treatment (ART). We assessed risk factors for incomplete adherence among a cohort of HIV-infected women initiating ART and examined associations between adherence and virologic response to ART.
  
  
  METHODS
  A secondary data analysis was conducted on a cohort of 154 women initiating non-nucleoside reverse transcriptase inhibitor (NNRTI)-based ART at a single site in Johannesburg, South Africa. Ninety women had been enrolled in a prevention of mother-to-child transmission (pMTCT) program and were exposed to single-dose nevirapine (sdNVP) >18 months earlier. Women were interviewed pre-treatment and clinical, virologic and adherence data were collected during follow-up to 24 weeks. Incomplete adherence to ART was defined as returning >5% of medications, estimated by pill counts at scheduled visits. Multivariable logistic regression analysis and unadjusted odds ratio (95%CI) were performed, using STATA/SE (ver 10.1).
  
  
  RESULTS
  About half of the women (53%) were <30 years of age, 63% had <11 years of schooling, 69% were unemployed and 37% lived in a shack. Seven percent of women had a viral load >400 copies/ml at 24 weeks and 37% had incomplete adherence at one or more visits. Incomplete adherence was associated with less education (p = 0.01) and lack of financial support from a partner (p = 0.02) after adjustment for confounders. Only when adherence levels dropped below 80% was there a significant association with viremia in the group overall (p = 0.02) although adherence <95% was associated with viremia in the sdNVP-exposed group (p = 0.03). The main reasons for incomplete adherence were being away from home, busy with other things and forgetting to take their medication.
  
  
  CONCLUSIONS
  Virologic response to NNRTI-treatment in the cohort was excellent. However, women who received sdNVP were at greater risk of virologic failure when adherence was <95%. Women exposed to sdNVP, and those with less education and less social support may benefit from additional adherence counseling to ensure the long-term success of ART. More than 80% adherence may be sufficient to maintain virologic suppression on NNRTI-based regimens in the short-term, however complete adherence should be encouraged.
authors.affiliation: Nordic School of Public Health (NHV), Gothenburg, Sweden.
authors.forename: Ziad
authors.initials: Z
authors.lastname: El-Khatib
authors.forename: Anna Mia
authors.initials: AM
authors.lastname: Ekstrom
authors.forename: Ashraf
authors.initials: A
authors.lastname: Coovadia
authors.forename: Elaine J
authors.initials: EJ
authors.lastname: Abrams
authors.forename: Max
authors.initials: M
authors.lastname: Petzold
authors.forename: David
authors.initials: D
authors.lastname: Katzenstein
authors.forename: Lynn
authors.initials: L
authors.lastname: Morris
authors.forename: Louise
authors.initials: L
authors.lastname: Kuhn
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D010349:Patient Compliance; D011446:Prospective Studies; D012307:Risk Factors; D013019:South Africa; D019562:Viral Load / Q000187:drug effects*
chemical_list: D044966:Anti-Retroviral Agents