title: Predictors of Nonadherence to Antiretroviral Therapy among HIV-Infected Adults in Dar es Salaam, Tanzania.
abstract: BACKGROUND
  Adherence rates of ≥95% to antiretroviral therapy (ART) are necessary to maintain viral suppression in HIV-infected individuals. We identified predictors of nonadherence to scheduled antiretroviral drug pickup appointments in a large HIV care and treatment program in Tanzania.
  
  
  METHODS
  We performed a prospective cohort study of 44, 204 HIV-infected adults on ART between November 2004 and September 2012. Multivariate generalized estimating equation for repeated binary data was used to estimate the relative risk and 95% confidence intervals of nonadherence.
  
  
  RESULTS
  Nonadherence was significantly greater among patients with high CD4 counts, high body mass indices, males, younger patients, patients with longer durations on ART, and those with perceived low social support.
  
  
  CONCLUSIONS
  Targeted interventions should be developed to improve ART adherence among healthier, younger, and more experienced patients who are on ART for longer durations within HIV care and treatment programs. Social support for patients on ART should be emphasized.
authors: Management and Development for Health, Dar es Salaam, Tanzania amuya@mdh-tz.org.
authors: Aisa N
authors: AN
authors: Muya
authors: Harvard School of Public Health, Boston, MA, USA.
authors: Pascal
authors: P
authors: Geldsetzer
authors: Harvard School of Public Health, Boston, MA, USA.
authors: Ellen
authors: E
authors: Hertzmark
authors: Department of Epidemiology & Biostatistics, The University of Georgia, Athens, GA, USA.
authors: Amara E
authors: AE
authors: Ezeamama
authors: Dar es Salaam City Council, Department of Health and Social services, Dar es Salaam, Tanzania.
authors: Hawa
authors: H
authors: Kawawa
authors: Northwestern University, Evanston, IL, USA.
authors: Claudia
authors: C
authors: Hawkins
authors: Management and Development for Health, Dar es Salaam, Tanzania.
authors: David
authors: D
authors: Sando
authors: Management and Development for Health, Dar es Salaam, Tanzania.
authors: Guerino
authors: G
authors: Chalamilla
authors: Harvard School of Public Health, Boston, MA, USA.
authors: Wafaie
authors: W
authors: Fawzi
authors: Harvard School of Public Health, Boston, MA, USA.
authors: Donna
authors: D
authors: Spiegelman
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D005544:Forecasting; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010361:Patients / Q000523:psychology*; D011446:Prospective Studies; D013636:Tanzania; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: HIV/AIDS; Tanzania; antiretroviral treatment; nonadherence