Field adherence to highly active antiretroviral therapy in HIV-infected adults in Abidjan, Cote d'Ivoire

Objectives: To estimate adherence to highly active antiretroviral therapy (HAART) and its determinants in HIV-infected adults followed in field conditions in Abidjan. Methods: A standardized questionnaire was administered to all consecutive adults on HAART who attended 3 urban HIV outpatient clinics. Patients were asked to self-report their pill intake during the previous 7 days, and, when necessary, to explain the reason(s) why they missed at least I intake. The adherence rate was estimated as the number of pills actually taken divided by the number of pills that should have been taken. The association of incomplete adherence (adherence rate <90%) with patients' characteristics was studied using niultivariate logistic regression. Results: Three hundred eight patients (inale/fernale ratio: 1: 1, mean time on HAART: 22 months) were interviewed. The median self-reported adherence rate was 78% (interquartile range: 65%-90%), with 76% of patients considered as incompletely adherent (adherence rate <90%). The most frequent self-reported reasons for missing at least 1 intake were an antiretroviral drug being out of stock in the clinic pharmacy (28%), the fear of drug side effects (27%), the impossibility of paying the drug's price (20%), and the intervention of traditional practitioners (18%). The only variables significantly independently associated with incomplete adherence were a school level >= secondary (odds ratio [OR] = 1.88; P = 0.03) and the absence of a patient's long-term formal commitment to adhere to HAART (OR = 3.08; P = 0.01). Conclusions: These data illustrate the difficulty in obtaining high levels of adherence in field conditions in Abidjan. Sustainable access to treatment should be promoted by combating access barriers such as running out of drugs and costs that are too high.