title: Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea.
abstract: Adherence to antiretroviral therapy (ART) is paramount for virological suppression and positive treatment outcomes. ART has been rapidly scaled up in Papua New Guinea (PNG) in recent years, however clinical monitoring of HIV+ individuals on ART is limited. A cross-sectional study was conducted at two major sexual health clinics in high HIV prevalence provinces in the Highlands Region of PNG to assess ART adherence, factors affecting adherence and the relationship between ART adherence and virological outcomes. Ninety-five HIV+ individuals were recruited and administered a questionnaire to gather demographic and ART adherence information whilst clinical data and pill counts were extracted from patient charts and blood was collected for viral load testing. Bivariate analysis was performed to identify independent predictors of ART adherence. Fourteen percent (n = 12) of participants showed evidence of virological failure. Although the majority of participants self-reported excellent ART adherence in the last seven days (78.9%, 75/91), pill count measurements indicated only 40% (34/84) with >95% adherence in the last month. Taking other medications while on ART (p = 0.01) and taking ART for ≥1 year (p = 0.037) were positively associated with adherence by self-report and pill count, respectively. Participants who had never heard of drug resistance were more likely to show virological failure (p = 0.033). Misconception on routes of HIV transmission still persists in the studied population. These findings indicate that non-adherence to ART is high in this region of PNG and continued education and strategies to improve adherence are required to ensure the efficacy of ART and prevent HIV drug resistance.
authors.affiliation: Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea; Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
authors.forename: Janet
authors.initials: J
authors.lastname: Gare
authors.affiliation: Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea; School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Angela
authors.initials: A
authors.lastname: Kelly-Hanku
authors.affiliation: Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Ryan
authors.affiliation: Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea.
authors.forename: Matthew
authors.initials: M
authors.lastname: David
authors.affiliation: HIV/STI Highlands Region, National Department of Health, Mt Hagen, Western Highlands Province, Papua New Guinea.
authors.forename: Petronia
authors.initials: P
authors.lastname: Kaima
authors.affiliation: Michael Alpers Clinic, Goroka General Hospital, Goroka, Eastern Highlands Province, Papua New Guinea.
authors.forename: Ulato
authors.initials: U
authors.lastname: Imara
authors.affiliation: Sexual and Reproductive Health Unit, Papua New Guinea Institute of Medical Research, Goroka, Eastern Highlands Province, Papua New Guinea.
authors.forename: Namarola
authors.initials: N
authors.lastname: Lote
authors.affiliation: Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
authors.forename: Suzanne M
authors.initials: SM
authors.lastname: Crowe
authors.affiliation: Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Hearps
mesh_terms: D000328:Adult; D000531:Altitude; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D058872:Epidemics / Q000517:prevention & control; D005260:Female; D005843:Geography; D006678:HIV / Q000187:drug effects* / Q000502:physiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010219:Papua New Guinea / Q000453:epidemiology; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D019562:Viral Load / Q000187:drug effects; D016903:Drug Monitoring