title: Patients' worries before starting antiretroviral therapy and their association with treatment adherence and outcomes: a prospective study in rural Uganda, 2004 - 2009.
abstract: BACKGROUND
  In HIV-infected persons, good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes. Patients' worries before starting ART may affect their ART adherence and treatment outcomes.
  
  
  METHODS
  Between 2004 and 2009, HIV-infected individuals in a prospective cohort study in rural Uganda were assessed for ART eligibility. A counsellor explained the ART eligibility criteria, adherence and side effects, and recorded the patients' worries related to ART. Every quarter, patients who initiated ART had clinical, immunological (CD4 cell counts) and virological (viral loads) assessments, and data were collected on ART adherence using patients' self-reports and pill counts. We describe the patients' worries and examine their association with ART adherence, and immunological and virological outcomes.
  
  
  RESULTS
  We assessed 421 patients, 271 (64%) were females, 318 (76%) were aged 30 years and above and 315 (75%) were eligible for ART. 277 (66%) reported any worry, and the proportions were similar by sex, age group and ART eligibility status. The baseline median CD4 counts and viral loads were similar among patients with any worry and those with no worry. The commonest worries were: fear of HIV serostatus disclosure; among 69 (16%) participants, lack of food when appetite improved after starting ART; 50 (12%), concurrent use of other medications; 33 (8%), adherence to ART; 28 (7%) and problems concerning condom use; 27 (6%). After 24 months or more on ART, patients who reported any worry had made more scheduled ART refill visits than patients who reported no worry (p<0.01), but the annual CD4 cell increases were similar (p=0.12). After one year on ART, patients who reported any worry had greater virological suppression than patients who reported no worry (p<0.05).
  
  
  CONCLUSIONS
  Despite the lack of significant associations of worries with unfavourable ART outcomes, physicians and counsellors should assist patients in overcoming their worries that can cause stress and discomfort. Food supplements may be desirable for some patients initiating ART.
authors: Billy N
authors: BN
authors: Mayanja
authors: Kenneth
authors: K
authors: Ekoru
authors: Harriet
authors: H
authors: Namugenyi
authors: Rosemary
authors: R
authors: Lubega
authors: Joseph O
authors: JO
authors: Mugisha
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D010349:Patient Compliance; D011446:Prospective Studies; D016896:Treatment Outcome; D014454:Uganda; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
references: J Acquir Immune Defic Syndr. 2007 Jul 1;45(3):355-8
references: 17438479
references: Afr J Tradit Complement Altern Med. 2009 Dec 30;7(2):125-37
references: 21304624
references: BMC Public Health. 2011 Nov 10;11:855
references: 22074367
references: AIDS. 2007 Jul 11;21(11):1486-7
references: 17589198
references: AIDS. 1997 Apr;11(5):633-40
references: 9108945
references: AIDS Behav. 2006 May;10(3):263-72
references: 16496089
references: J Acquir Immune Defic Syndr. 2002 Dec 15;31 Suppl 3:S154-7
references: 12562041
references: AIDS Clin Care. 1998 Aug;10(8):57-9
references: 11365682
references: AIDS Patient Care STDS. 2009 May;23(5):377-87
references: 19327098
references: Psychol Health Med. 2007 May;12(3):314-20
references: 17510901
references: AIDS Behav. 2006 Sep;10(5):483-93
references: 16721505
references: AIDS Behav. 2006 Jul;10(4):437-42
references: 16636892
references: BMC Public Health. 2008 Feb 29;8:81
references: 18312653
references: Lancet. 2003 Jul 5;362(9377):22-9
references: 12853195
references: AIDS. 2006 Jan 2;20(1):85-92
references: 16327323
references: Int J Epidemiol. 2002 Oct;31(5):961-7
references: 12435768
references: Int J STD AIDS. 2005 Jan;16(1):38-41
references: 15705271
references: Nutr J. 2005 May 31;4:19
references: 15927053
references: Lancet. 2008 Mar 1;371(9614):752-9
references: 18313504
references: AIDS Behav. 2008 Mar;12(2):232-43
references: 17828450
references: Bull World Health Organ. 2004 Apr;82(4):299-307
references: 15259260
references: AIDS Care. 2005 Nov;17(8):949-57
references: 16176891
references: Niger J Med. 2005 Jul-Sep;14(3):290-4
references: 16350700
references: AIDS. 1994 Jan;8(1):87-92
references: 8011241
references: AIDS Read. 2000 Dec;10(12):709-17
references: 11189742
references: J Acquir Immune Defic Syndr. 2007 Jun 1;45 Suppl 1:S14-8
references: 17525686
references: Am J Trop Med Hyg. 2007 Oct;77(4):757-63
references: 17978084
references: AIDS. 2006 Oct 24;20(16):2116-8
references: 17053359
references: PLoS Med. 2006 Nov;3(11):e438
references: 17121449