RESUMO
Background: Adherence to antiretroviral therapy (ART) is necessary to achieve best virological response, lower the risk of drug resistance, and reduce morbidity and mortality. The objectives of the current study were to assess the extent of knowledge of patients on treatment plan and regimen, determine the rate of adherence and identify factors related to non-adherence to ART. Methods: A cross-sectional study was conducted at Tikur Anbessa Specialized Teaching Hospital, Addis Ababa, Ethiopia, using data from both semi-structured interview (self-report) and ART database (pharmacy refi ll) during the months of March and April 2013 using a total 350 participants. Results: The results indicated that 33% of the participants had good knowledge on the treatment plan and regimen. Using self-report and pharmacy refi ll record, 79.1% and 72.9% respectively showed adherence rate of ≥95%. Younger people were found to be less likely to adhere to ART (AOR [95%] = 0.51 [0.30, 0.85]) using pharmacy refi ll record. Risk factors for ART non-adherence using self-report were use of memory aids (AOR [95%] = 3.46 [1.72, 6.98]), treatment satisfaction (AOR [95%] = 2.33 [1.22, 4.07]), taking co-medication (AOR [95%] = 0.56 [0.32, 0.98]), and regimen switch (AOR [95%] = 0.41 [0.19, 0.85]). Whereas using pharmacy refill record risk factors were, knowledge on treatment plan and regimen (AOR [95%] = 2.50 [1.39, 4.51]), use of memory aids (AOR [95%] = 2.71 [1.34, 5.47]), treatment satisfaction (AOR [95%] = 3.78 [1.47, 9.71]), and regimen switch (AOR [95%] = 0.50 [0.27, 0.92]). Conclusion: Older age, good knowledge on treatment plan and regimen, use of memory aids, treatment satisfaction, and not having co-medications and regimen switch showed more adherence to ART.
RESUMO
Background: Tuberculosis is a major opportunistic complication of HIV-infection. Antiretroviral therapy (ART) lowers incidence of tuberculosis (TB) but may not be sufficient to control HIV-related tuberculosis, implying a need for additional interventions. The aim of this study was to compare the effects of isoniazid preventive therapy (IPT) plus ART and ART only regimens on the incidence of active TB and HIV progression in HIV positive patients. Methods: The retrospective cohort study was conducted at Tikur Anbessa Specialized Hospital and Zewditu Memorial Hospital on 185 patients receiving IPT plus ART and 557 patients receiving ART only. Incidence rates (IR) were used to determine incidence rates of tuberculosis. Time to AIDS and TB event were compared using student t-test. Risks of the outcomes were identified using regression models. Results: The study showed a reduced tuberculosis incidence rate from 7.44 to 1.8 cases/100 person-years [PYs] by IPT plus ART compared to ART only. In reference to ART alone, the IPT plus ART significantly reduced risks of active TB (adjusted odds ratio [AOR] 0.24; 95% CI 0.09–0.63; P=0.004) and had about 16 months of TB protection (P<0.001). In addition, the IPT plus ART delayed HIV progression to AIDS more significantly than the ART only (P=0.029). However, it increased risks of adverse events (AOR 3.33; 95% CI 1.35–8.19; P=0.01) more than the ART only. Conclusions: The wider use of IPT with ART impacts more on incidence of tuberculosis and time to AIDS while simultaneously increasing risks of adverse events than the ART only.