Non-adherence to antiretroviral therapy in Yaounde: Prevalence, determinants and the concordance of two screening criteria

ABSTRACT

To assess the prevalence and determinants of non-adherence to antiretroviral therapy [ART] as well as the concordance of two screening criteria in a major center for human immunodeficiency virus [HIV] treatment in Yaounde, Cameroon. In 2011, we conducted a cross-sectional study involving a random sample of 889 adults [age > 18 years, 67.9% women] infected with HIV who were receiving chronic care at the Yaounde Jamot Hospital. Adherence was assessed via self-administered questionnaires using the Community Programs for Clinical Research on AIDS [CPCRA] index and the Center for Adherence Support Evaluation [CASE] index. The prevalence of non-adherence to ART was 22.5% based on the CPCRA index and 34.9% based on the CASE index, with a low agreement between the two indexes [kappa = 0.37 [95% confidence interval 0.31-0.44]]. Independent determinants of CPCRA-diagnosed non-adherence were as follows being a remunerated employee [odds ratio [95% confidence interval] 1.61 [1.14-2.28]], Pentecostal Christianity [2.18 [1.25-3.80]], alcohol consumption [1.65 [1.16-2.34]] and non-adherence to cotrimoxazole prophylaxis [5.73 [3.92-8.38]]. The equivalents for CASE-diagnosed non-adherence were [1.59 [1.19-2.12]], [1.83 [1.36-2.47]], [1.70 [1.27-2.28]], respectively, in addition to association with changes to the ART regimen [1.61 [1.17-2.20]]. Non-adherence to ART remains high in this population. The careful evaluation of patients for the presence of determinants of non-adherence identified in this study may aid ART optimization