The global response to the HIV/AIDS epidemic has resulted in a dramatic increase in access to antiretroviral therapy (ART) and has contributed to decreased HIV/AIDS morbidity and mortality in Sub-Saharan Africa. Long-term success of HIV treatment crucially depend on patient adherence. However, little is known about the correlates of adherence to ART among people living with HIV/AIDS (PLWHA) in the Democratic Republic of Congo (DRC).
To address this research gap, we undertook a mixed method study including a preliminary qualitative study followed by a quantitative study, to document correlates of patient adherence to ART in the DRC.
The qualitative study used in-depth semi-structured patient interviews, a purposive sampling strategy and thematic analysis scheme to identify barriers and facilitators of adherence to ART in the DRC. In total, 38 participants categorized in three groups (participants on antiretroviral (ARV) treatment (n=19), on ARV re-treatment (n=13) and lost to follow up (n=6)), were recruited from the two selected health facilities. Overall, food insecurity emerged as the most important barrier to ART adherence among our participants. Other barriers included financial constraints, forgetfulness and fear of disclosure/stigma.
Based on these results, our cross-sectional quantitative study devised to ascertain the association of 1) food insecurity, and 2) other correlates, with patient adherence to ART. Through a consecutive sampling strategy, 898 participants were recruited into the study, of which 512 (57%) were food insecure, and 188 (20.9%) were not adherent to ART. Food insecurity, as measured by the Household Food Insecurity Access Scale, was significantly associated with non-adherence to ART (AOR, 2.06; CI, 1.38-3.09). We also found that perceived harmfulness of ART and psychological distress were associated respectively with increased (AOR, 1.95; CI, 1.15-3.32) and decreased (AOR, 0.31; CI, 0.11-0.83) odds of non-adherence to ART.
Our findings indicate that food insecurity is a prevalent and a significant risk factor for non-adherence to ART among HIV-infected individuals in the DRC. This study highlights the urgent need for strategies to improve food access among HIV-infected on ART in order to ensure patient adherence to ART and ultimately the long-term success of HIV treatment in Sub-Saharan Africa.
Moderator: Dr.Jongjit Rittirong
* Researcher, Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University
January 14, 2015