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
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Date
2008
Journal Title
Journal ISSN
Volume Title
Publisher
BMC health services research
Abstract
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.
Methods: 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/mm3. Kaplan
Meier curves and Cox proportional hazards regression models were used in the analysis.
Results: 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/mm3 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/mm3 (HR = 2.4; 95% CI: 1.79–2.38).
Conclusion: 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.
Description
Keywords
Adherence, HAART, Community HIV/AIDS treatment, Care programme, The AIDS Support Organization (TASO), Uganda
Citation
Abaasa, A. M., Todd, J., Ekoru, K., Kalyango, J. N., Levin, J., Odeke, E., & Karamagi, C. A. (2008). 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, 8(1), 1-10. doi:10.1186/1472-6963-8-241