Date Published: March 1, 2011
Publisher: Public Library of Science
Author(s): Michael H. Chung, Barbra A. Richardson, Kenneth Tapia, Sarah Benki-Nugent, James N. Kiarie, Jane M. Simoni, Julie Overbaugh, Mena Attwa, Grace C. John-Stewart, Edward J. Mills
Abstract: Michael Chung and colleagues show that intensive early adherence counseling at HAART initiation resulted in sustained, significant impact on adherence and virologic treatment failure, whereas use of an alarm device had no effect.
Partial Text: The introduction of antiretroviral medications on a public health scale to treat HIV-positive persons in sub-Saharan Africa has been accompanied by concern that these actions will result in widespread viral resistance because of poor adherence . However, recent studies have shown that adherence is high in African HIV treatment programs and often better than in Western HIV clinics ,. In a meta-analysis of 27 cohorts from 12 African countries, adequate adherence was noted in 77% of participants compared to only 55% among 31 North America cohorts .
In this randomized controlled trial comparing counseling and the use of an alarm device to improve adherence to antiretroviral medications in Kenya, participants receiving intensive early adherence counseling were 59% (HR 0.41; 95% CI 0.21–0.81; p = 0.01) less likely to experience viral failure, demonstrating the powerful impact of this behavioral intervention on biological outcomes. Although poor adherence has been associated with plasma HIV-1 viral rebound and development of viral resistance ,, few trials have demonstrated an association between an intervention designed to improve adherence and virologic impact ,–. This study found a significant association between having received adherence counseling and antiretroviral treatment failure as defined by the WHO .