title: Adherence to antiretroviral therapy (ART) during the early months of treatment in rural Zambia: influence of demographic characteristics and social surroundings of patients.
abstract: BACKGROUND
  Around 70% of those living with HIV in need of treatment accessed antiretroviral therapy (ART) in Zambia by 2009. However, sustaining high levels of adherence to ART is a challenge. This study aimed to identify the predictive factors associated with ART adherence during the early months of treatment in rural Zambia.
  
  
  METHODS
  This is a field based observational longitudinal study in Mumbwa district, which is located 150 km west of Lusaka, the capital of Zambia. Treatment naive patients aged over 15 years, who initiated treatment during September-November 2010, were enrolled. Patients were interviewed at the initiation and six weeks later. The treatment adherence was measured according to self-reporting by the patients. Multiple logistic regression analysis was performed to identify the predictive factors associated with the adherence.
  
  
  RESULTS
  Of 157 patients, 59.9% were fully adherent to the treatment six weeks after starting ART. According to the multivariable analysis, full adherence was associated with being female [Adjusted Odds Ratio (AOR), 3.3; 95% Confidence interval (CI), 1.2-8.9], having a spouse who were also on ART (AOR, 4.4; 95% CI, 1.5-13.1), and experience of food insufficiency in the previous 30 days (AOR, 5.0; 95% CI, 1.8-13.8). Some of the most common reasons for missed doses were long distance to health facilities (n = 21, 53.8%), food insufficiency (n = 20, 51.3%), and being busy with other activities such as work (n = 15, 38.5%).
  
  
  CONCLUSIONS
  The treatment adherence continues to be a significant challenge in rural Zambia. Social supports from spouses and people on ART could facilitate their treatment adherence. This is likely to require attention by ART services in the future, focusing on different social influences on male and female in rural Zambia. In addition, poverty reduction strategies may help to reinforce adherence to ART and could mitigate the influence of HIV infection for poor patients and those who fall into poverty after starting ART.
authors.affiliation: Department of Infection Control and Prevention, Graduate School of Nursing, Nagoya City University, Kawasumi 1, Mizuho-ku, Nagoya-shi, Aichi, 467-8601, Japan. yurippe1006@hotmail.com
authors.forename: Yuri
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Kakimoto
authors.forename: Christopher
authors.initials: C
authors.lastname: Dube
authors.forename: Izukanji
authors.initials: I
authors.lastname: Sikazwe
authors.forename: Crispin
authors.initials: C
authors.lastname: Moyo
authors.forename: Gardner
authors.initials: G
authors.lastname: Syakantu
authors.forename: Kenichi
authors.initials: K
authors.lastname: Komada
authors.forename: Shinsuke
authors.initials: S
authors.lastname: Miyano
authors.forename: Naoko
authors.initials: N
authors.lastname: Ishikawa
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kita
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kai
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016001:Confidence Intervals; D003710:Demography; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011237:Predictive Value of Tests; D019035:Rural Health Services; D012424:Rural Population; D057566:Self Report; D057545:Social Stigma; D012944:Social Support; D013997:Time Factors; D055815:Young Adult; D015024:Zambia
chemical_list: D044966:Anti-Retroviral Agents