title: Adherence to antiretroviral treatment by adults in a rural area of Botswana.
abstract: BACKGROUND
  As antiretroviral therapy (ART) is becoming increasingly available to people in developing countries, ART adherence challenges assume ever greater significance. Often underlying treatment failure is the fact that suboptimal adherence to ART is the strongest predictor of failure to achieve viral suppression below the level of detection.
  
  
  OBJECTIVE
  The study's main objective was to identify factors affecting ART adherence levels, as well as the impact on immunologic and virologic responses in adult patients in one rural district in Botswana.
  
  
  METHODS
  A cross-sectional quantitative survey, was used. Structured interviews were conducted with 300 ART patients between November 2011 and February 2012. Data were analysed, then presented in charts, graphs and frequency tables.
  
  
  RESULTS
  The prevalence of non-adherence to ART was 14.0%. Motivators of good adherence included disclosure of HIV-positive status to more than one person, frequent adherence counselling, self-efficacy for adherence to ART, positive interactions between patients and healthcare providers; and using adherence partners. Barriers to adherence were forgetfulness, transportation costs to and from the clinic, time away from work and side-effects. There was a strong positive correlation between adherence, CD4 counts and viral load. Adherence was closely tied to immunologic and virologic improvements. Respondents with poor adherence were likely to have unsuppressed viral loads (OR 12.98, 95% CI 4.9-34).
  
  
  CONCLUSIONS
  Adherence to ART is closely tied to virologic, immunologic, and clinical outcomes. Increases in adherence levels resulted in significant improvements in these outcomes. Near perfect adherence, however, is required to maximise the likelihood of long-term clinical success, which could pose challenges to many ART patients, especially in resource-limited rural settings.
authors.affiliation: Department of Health Studies, University of South Africa. ehlersjh@mweb.co.za.
authors.forename: Valerie J
authors.initials: VJ
authors.lastname: Ehlers
authors.forename: Emmanuel T
authors.initials: ET
authors.lastname: Tshisuyi
mesh_terms: D000328:Adult; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001902:Botswana; D018791:CD4 Lymphocyte Count / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D005260:Female; D006678:HIV / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data; D019562:Viral Load / Q000706:statistics & numerical data; D055815:Young Adult; D016903:Drug Monitoring
chemical_list: D044966:Anti-Retroviral Agents