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Improving adherence to antiretroviral therapy in sub-Saharan African HIV-positive populations: An enhanced adherence package

机译：改善对撒哈拉以南非洲HIV阳性人群的抗逆转录病毒疗法的依从性：增强的依从性方案

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With the increasing access to antiretroviral therapy in sub-Saharan African HIV-positive populations, it is important to find additional simple, effective, and feasible methods of improving and maintaining adequately high levels of adherence. In this study, we undertook the development, testing, implementation, and evaluation of various adherence support interventions at four sites in Uganda. A one-group pre-and post-intervention design was employed under routine operational conditions. Various adherence support strategies were identified, adapted, and developed. These strategies which included a combination of elements such as counseling, group education, leaflets, late attendee tracing, and adherence diaries was implemented for an antiretroviral treatment cohort which had baseline levels of adherence measured preintervention. Follow-up was from August 2009 through August 2010. Mean adherence and proportions of clients achieving adherence levels of 95% and above were determined at end of follow-up. Of the 967 participants enrolled, 856 (88.5%) completed follow-up. A before-and-after comparison of outcomes demonstrated that mean adherence (95% confidence interval [CI]) improved statistically significant from baseline following implementation of the interventions (97.4% [96.9-97.9%] to 99.1% [99.0-99.3%], P=0.001). There was also a significant difference between proportions with optimal (95%) and suboptimal adherence (<95%) pre-and post-intervention (7.0% difference, 95% CI: 4.6-9.4%, P<0.001). We conclude that additional adherence strategies (including counseling, group education, leaflets, late attendee tracing, and adherence diaries) can substantially improve and maintain high levels of treatment adherence in the long term. Health systems in sub-Saharan African countries should consider integrating these elements into their treatment programs for HIV/AIDS.
机译：随着撒哈拉以南非洲HIV阳性人群中获得抗逆转录病毒疗法的机会越来越多，重要的是找到其他简单，有效和可行的方法来改善和维持足够高的依从性。在这项研究中，我们在乌干达的四个地点进行了各种坚持支持干预措施的开发，测试，实施和评估。在常规操作条件下采用一组干预前后的设计。确定，调整和开发了各种坚持支持策略。这些策略包括咨询，小组教育，传单，晚期与会者追踪和依从性日记等要素的组合，是针对一项抗逆转录病毒治疗队列实施的，该队列的基线依从性为干预前水平。随访时间为2009年8月至2010年8月。在随访结束时确定平均依从性和达到95％及以上的依从性的客户比例。在967位参与者中，有856位（88.5％）完成了随访。前后比较结果表明，实施干预措施后，平均依从性（95％置信区间[CI]）与基线相比有统计学意义的提高（97.4％[96.9-97.9％]至99.1％[99.0-99.3％]） ，P ＝ 0.001）。干预前后最佳依从性（95％）和次优依从性（<95％）的比例之间也存在显着差异（差异为7.0％，95％CI：4.6-9.4％，P <0.001）。我们得出结论，从长远来看，其他的依从性策略（包括咨询，团体教育，传单，后期参与者追踪和依从性日记）可以显着改善并维持高水平的依从性。撒哈拉以南非洲国家的卫生系统应考虑将这些要素纳入其艾滋病毒/艾滋病治疗方案。

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