title: Neuropsychiatric and socioeconomic status impact antiretroviral adherence and mortality in rural Zambia.
abstract: We conducted a prospective cohort study of 496 adults starting antiretroviral treatment (ART) to determine the impact of neuropsychiatric symptoms and socioeconomic status on adherence and mortality. Almost 60% had good adherence based upon pharmacy records. Poor adherence was associated with being divorced, poorer, food insecure, and less educated. Longer travel time to clinic, concealing one's human immunodeficiency virus (HIV) status, and experiencing side effects predicted poor adherence. Over a third of the patients had cognitive impairment and poorer cognitive function was also associated with poor adherence. During follow-up (mean 275 days), 20% died-usually within 90 days of starting ART. Neuropsychiatric symptoms, advanced HIV, peripheral neuropathy symptoms, food insecurity, and poverty were associated with death. Neuropsychiatric symptoms, advanced HIV, and poverty remained significant independent predictors of death in a multivariate model adjusting for other significant factors. Social, economic, cognitive, and psychiatric problems impact adherence and survival for people receiving ART in rural Zambia.
authors: Michigan State University, International Neurologic and Psychiatric Epidemiology Program, East Lansing, Michigan, USA. birbeck@msu.edu
authors: Gretchen L
authors: GL
authors: Birbeck
authors: Michelle P
authors: MP
authors: Kvalsund
authors: Peter A
authors: PA
authors: Byers
authors: Richard
authors: R
authors: Bradbury
authors: Charles
authors: C
authors: Mang'ombe
authors: Natalie
authors: N
authors: Organek
authors: Trevor
authors: T
authors: Kaile
authors: Alex M
authors: AM
authors: Sinyama
authors: Sylvester S
authors: SS
authors: Sinyangwe
authors: Kennedy
authors: K
authors: Malama
authors: Costantine
authors: C
authors: Malama
mesh_terms: D000328:Adult; D015658:HIV Infections / Q000188:drug therapy* / Q000401:mortality; D006801:Humans; D010349:Patient Compliance; D011446:Prospective Studies; D012923:Social Class; D015024:Zambia / Q000453:epidemiology