Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda
<p>Abstract</p> <p>Background</p> <p>Poor adherence to highly active antiretroviral therapy (HAART) may result in treatment failure and death. Most reports of the effect of adherence to HAART on mortality come from studies where special efforts are made to provide HAART...
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| Format: | Article |
| Language: | English |
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BMC
2008-11-01
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| Series: | BMC Health Services Research |
| Online Access: | http://www.biomedcentral.com/1472-6963/8/241 |
| _version_ | 1811248156845801472 |
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| author | Kalyango Joan N Ekoru Kenneth Todd Jim Abaasa Andrew M Levin Jonathan Odeke Emmanuel Karamagi Charles AS |
| author_facet | Kalyango Joan N Ekoru Kenneth Todd Jim Abaasa Andrew M Levin Jonathan Odeke Emmanuel Karamagi Charles AS |
| author_sort | Kalyango Joan N |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>Poor adherence to highly active antiretroviral therapy (HAART) may result in treatment failure and death. Most reports of the effect of adherence to HAART on mortality come from studies where special efforts are made to provide HAART under ideal conditions. However, there are few reports of the impact of non-adherence to HAART on mortality from community HIV/AIDS treatment and care programmes in developing countries. We therefore conducted a study to assess the effect of adherence to HAART on survival in The AIDS Support Organization (TASO) community HAART programme in Kampala, Uganda.</p> <p>Methods</p> <p>The study was a retrospective cohort of 897 patients who initiated HAART at TASO clinic, Kampala, between May 2004 and December 2006. A total of 7,856 adherence assessments were performed on the data. Adherence was assessed using a combination of self-report and pill count methods. Patients who took ≤ 95% of their regimens were classified as non-adherent. The data was stratified at a CD4 count of 50 cells/mm<sup>3</sup>. Kaplan Meier curves and Cox proportional hazards regression models were used in the analysis.</p> <p>Results</p> <p>A total of 701 (78.2%) patients had a mean adherence to ART of > 95%. The crude death rate was 12.2 deaths per 100 patient-years, with a rate of 42.5 deaths per 100 patient-years for non-adherent patients and 6.1 deaths per 100 patient-years for adherent patients. Non-adherence to ART was significantly associated with mortality. Patients with a CD4 count of less than 50 cells/mm<sup>3 </sup>had a higher mortality (HR = 4.3; 95% CI: 2.22–5.56) compared to patients with a CD4 count equal to or greater than 50 cells/mm<sup>3 </sup>(HR = 2.4; 95% CI: 1.79–2.38).</p> <p>Conclusion</p> <p>Our study showed that good adherence and improved survival are feasible in community HIV/AIDS programmes such as that of TASO, Uganda. However, there is need to support community HAART programmes to overcome the challenges of funding to provide sustainable supplies particularly of antiretroviral drugs; provision of high quality clinical and laboratory support; and achieving a balance between expansion and quality of services. Measures for the early identification and treatment of HIV infected people including home-based VCT and HAART should be strengthened.</p> |
| first_indexed | 2024-04-12T15:22:07Z |
| format | Article |
| id | doaj.art-d621b16bbd5f4da3847ad50a7275d5ff |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-04-12T15:22:07Z |
| publishDate | 2008-11-01 |
| publisher | BMC |
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| series | BMC Health Services Research |
| spelling | doaj.art-d621b16bbd5f4da3847ad50a7275d5ff2022-12-22T03:27:24ZengBMCBMC Health Services Research1472-69632008-11-018124110.1186/1472-6963-8-241Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, UgandaKalyango Joan NEkoru KennethTodd JimAbaasa Andrew MLevin JonathanOdeke EmmanuelKaramagi Charles AS<p>Abstract</p> <p>Background</p> <p>Poor adherence to highly active antiretroviral therapy (HAART) may result in treatment failure and death. Most reports of the effect of adherence to HAART on mortality come from studies where special efforts are made to provide HAART under ideal conditions. However, there are few reports of the impact of non-adherence to HAART on mortality from community HIV/AIDS treatment and care programmes in developing countries. We therefore conducted a study to assess the effect of adherence to HAART on survival in The AIDS Support Organization (TASO) community HAART programme in Kampala, Uganda.</p> <p>Methods</p> <p>The study was a retrospective cohort of 897 patients who initiated HAART at TASO clinic, Kampala, between May 2004 and December 2006. A total of 7,856 adherence assessments were performed on the data. Adherence was assessed using a combination of self-report and pill count methods. Patients who took ≤ 95% of their regimens were classified as non-adherent. The data was stratified at a CD4 count of 50 cells/mm<sup>3</sup>. Kaplan Meier curves and Cox proportional hazards regression models were used in the analysis.</p> <p>Results</p> <p>A total of 701 (78.2%) patients had a mean adherence to ART of > 95%. The crude death rate was 12.2 deaths per 100 patient-years, with a rate of 42.5 deaths per 100 patient-years for non-adherent patients and 6.1 deaths per 100 patient-years for adherent patients. Non-adherence to ART was significantly associated with mortality. Patients with a CD4 count of less than 50 cells/mm<sup>3 </sup>had a higher mortality (HR = 4.3; 95% CI: 2.22–5.56) compared to patients with a CD4 count equal to or greater than 50 cells/mm<sup>3 </sup>(HR = 2.4; 95% CI: 1.79–2.38).</p> <p>Conclusion</p> <p>Our study showed that good adherence and improved survival are feasible in community HIV/AIDS programmes such as that of TASO, Uganda. However, there is need to support community HAART programmes to overcome the challenges of funding to provide sustainable supplies particularly of antiretroviral drugs; provision of high quality clinical and laboratory support; and achieving a balance between expansion and quality of services. Measures for the early identification and treatment of HIV infected people including home-based VCT and HAART should be strengthened.</p>http://www.biomedcentral.com/1472-6963/8/241 |
| spellingShingle | Kalyango Joan N Ekoru Kenneth Todd Jim Abaasa Andrew M Levin Jonathan Odeke Emmanuel Karamagi Charles AS Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda BMC Health Services Research |
| title | Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda |
| title_full | Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda |
| title_fullStr | Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda |
| title_full_unstemmed | Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda |
| title_short | Good adherence to HAART and improved survival in a community HIV/AIDS treatment and care programme: the experience of The AIDS Support Organization (TASO), Kampala, Uganda |
| title_sort | good adherence to haart and improved survival in a community hiv aids treatment and care programme the experience of the aids support organization taso kampala uganda |
| url | http://www.biomedcentral.com/1472-6963/8/241 |
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