Adherence & Retention
Adherence to antiretroviral therapy in resource limited settings: everything matters
Adherence is one of the major determinants of successful outcomes to antiretroviral therapy (ART) among HIV-infected individuals. In several studies, poor adherence, especially at levels < 95%, has been found to be associated with development of viral resistance, virological failure, progression of disease, and death. Adherence is particularly important in resource-limited settings. This is mainly because of poor access to care and monitoring and limited availability of alternative regimens. Despite numerous studies of outcomes with ART in resource-limited settings, surprisingly few have addressed adherence. Those that have report mostly encouraging results, with adherence rates similar to those observed in developed countries, although notable declines among individuals on more long-term therapy are beginning to be observed. Interesting findings concerning barriers to adherence have also been reported in these studies. More commonly, financial constraints and disruptions in the supply of medications are reported as the major barriers to adherence in resource-limited settings, contrasting significantly with the barriers typically reported in developed countries, such as side effects, stigma, or inconvenience. The findings should raise considerable concern given the uncertainty of long-term donor commitments in resource-limited settings and eventual probability of patients having to pay at least some if not all costs of therapy.
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