Adherence and Treatment Change among HIV/AIDS Patients in Ghana A Nested Case Control Study
- *Corresponding Author:
- Daniel NA Ankrah
Korle-Bu Teaching Hospital, P.O. Box 77, Korle-Bu, Accra
Ghana and Division of Pharmacoepidemiology & Clinical Pharmacology
Utrecht Institute for Pharmaceutical Sciences (UIPS), PO Box 80082
3508 TB Utrecht, the Netherlands
E-mail: [email protected]; [email protected]
Received date: September 10, 2015; Accepted date: October 13, 2015; Published date: October 21, 2015
Citation: Ankrah DNA, Lartey M, Agyepong I, Hubert GM, Mantel-Teeuwisse AK (2015) Adherence and Treatment Change among HIV/AIDS Patients in Ghana – A Nested Case Control Study. J AIDS Clin Res 6:510. doi:10.4172/2155- 6113.1000510
Copyright: © 2015 Ankrah DNA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Objective: A level of 95% adherence to antiretroviral therapy (ART) has been found to benefit HIV/AIDS patients. Low adherence may lead to treatment failure, and may subsequently result in treatment change. The main objective of this study was to evaluate the effect of ART adherence on treatment change
Methods: Data were extracted from available written clinical and pharmacy records, and the electronic database at the Korle-Bu Teaching Hospital. Cases comprised all those (≥15 years) who experienced a first treatment change after starting first-line ART between 1/1/2004 and 31/12/2009. Controls (who did not change treatment) were sampled from the same cohort of ART starters and matched to cases on date ART was started. Adherence was determined using the proportion of days covered (PDC) approach and poor adherence was defined as PDC levels below 95%. Measures of effect were calculated using conditional logistic regression.
Results: The 298 cases and 298 matched controls were similar in most baseline characteristics. Among cases 20.1% (60/298) switched to second-line therapy and the rest had treatment substitutions. Overall, 88.9% of controls compared with 79.9% of cases had adherence levels greater than or equal to 95% (p=0.003). After adjusting for possible confounders, an adherence level below 95% was associated with almost four times (ORadj=3.56 (95% CI 1.60 to 7.88)) the likelihood of having a treatment change.
Conclusion: This study showed that insufficient ART adherence was associated with about four times the likelihood of treatment change. Policy makers must partner researchers to engage patients more often, to unravel the causes of non-adherence, and make the necessary interventions for patients to achieve maximum benefits from dispensed medicines.