XVIII International AIDS Conference (AIDS 2010)
18–23 July 2010
"Nonadherence to antiretroviral therapy in Vietnam: Prevalence and clinical, social, and psychological correlates"
Hoa Mai Do, M.P. Dunne, C.V. Pham, and M. Kato
The antiretroviral therapy (ART) program in Viet Nam has scaled up rapidly, from 2,700 patients in 2005 to more than 35,000 by September 2009. Nonadherence to ART and factors that limit adherence have not been systematically researched in this country. The present study examined nonadherence in relation to a range of demographic, clinical, social, and psychological factors.
Careful pilot work ensured that the measurement tools were culturally appropriate. Data were collected from interviews with 615 HIV-positive adult patients on ART in five rural and urban outpatient clinics in Vietnam using an audio computer-assisted self-interview (ACASI) and clinical records extraction.
Non-adherence was 24.9 percent (estimated from a visual analogue scale of past-month dose-missing). Logistic regression revealed that variables significantly associated with nonadherence were: heavy alcohol use (p=0.001), illicit drug use (p=0.029), depression (p< 0.001), medication side-effect experiences (p<0.001), chance health locus of control (p=0.001), perceived quality of information from providers (p=0.011), satisfaction with family support (p=0.004), and social connectedness (p=0.029). No multivariate association was observed between ART adherence and age, gender, education, duration of ART, prior treatment for opportunistic infection, or distance between clinic and patients' residence.
This is the largest study yet reported in Asia to examine nonadherence to ART and its possible determinants. The evidence strongly supports recent calls from other developing nations for HIV/AIDS services to provide screening, counseling, and treatment for patients with depressive symptoms, heavy use of alcohol, and substance abuse. Counseling should also address fatalistic beliefs about chance or luck determining health outcomes. The data suggest that adherence could be enhanced by assisting patients to maintain social connectedness with family and the community. This study also demonstrated the utility of the ACASI method to enhance open disclosure by people living with HIV/AIDS in Asia.
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