Adherence to Antiretroviral Therapy; Virologic Failure and Workload at the Rustenburg Provincial Hospital

ABSTRACT

Background: Adherence to antiretroviral therapy (ART) is a strong predictor of progression to AIDS and death. It remains the most important potentially alterable factor that determines treatment outcomes. Methods: The study is a cross-sectional survey of self-reported adherence to ART and associated factors. It included a randomly selected sample of 100 adult patients who began ART between June 2006 and December 2007. A modified Adult AIDS Clinical Trials Group questionnaire was used. The analysis compared self-reported adherence levels by factor and viral load test results. Results: Only 71of patients had an adherence 95. Poor adherence was related to changes in daily routines (being away from home [21] and busy with other things [17]). All patients with symptoms suggestive of clinical depression had virologic failure. More unemployed patients (50.7) had virologic failure than did employed patients (40) (p = 0.05). The clinic had a tenfold increase in patient enrolment and a ninefold decline in staff-to-patient ratio; and the proportion of patients lost to follow-up doubled in the preceding four years. Conclusion: Adherence to ART was poor. The capacity of the clinic to manage patients adequately has declined significantly. Decentralisation of ART services to primary health care facilities should be considered