Research Article: Older Adults Accessing HIV Care and Treatment and Adherence in the IeDEA Central Africa Cohort

Date Published: February 16, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Jamie Newman, Jeniffer Iriondo-Perez, Jennifer Hemingway-Foday, Anna Freeman, Wilfred Akam, Ashu Balimba, Lucien Kalenga, Marcel Mbaya, Brigitte Mfangam Molu, Henri Mukumbi, Théodore Niyongabo, Joseph Atibu, Innocent Azinyue, Modeste Kiumbu.

http://doi.org/10.1155/2012/725713

Abstract

Background. Very little is known about older adults accessing HIV care in sub-Saharan Africa. Materials and Methods. Data were obtained from 18,839 HIV-positive adults at 10 treatment programs in Burundi, Cameroon, and the Democratic Republic of Congo. We compared characteristics of those aged 50+ with those aged 18–49 using chi-square tests. Logistic regression was used to determine if age was associated with medication adherence. Results. 15% of adults were 50+ years. Those aged 50+ were more evenly distributed between women and men (56% versus 44%) as compared to those aged 18–49 (71% versus 29%) and were more likely to be hypertensive (8% versus 3%) (P < 0.05). Those aged 50+ were more likely to be adherent to their medications than those aged 18–49 (P < 0.001). Adults who were not heavy drinkers reported better adherence as compared to those who reported drinking three or more alcoholic beverages per day (P < 0.001). Conclusions. Older adults differed from their younger counterparts in terms of medication adherence, sociodemographic, behavioral, and clinical characteristics.

Partial Text

2.8 million people living with HIV worldwide are over the age of 50 [1]. In the USA, 24% of all people living with HIV are older than 50 [2]. In sub-Saharan Africa, more than 14% of adults with HIV are 50 years or older, and this population is growing [3]. Perceived risk of contracting HIV among older adults is low [4] despite physiological changes associated with aging which place older adults at increased risk of contracting HIV [5, 6]. HIV disease progresses more rapidly among older adults than among their younger counterparts, and mortality among older adults is higher after developing an AIDS-defining illness [7, 8].

The HIV-infected adults included in this analysis were receiving care at 10 HIV care and treatment facilities contributing data to the IeDEA Central Africa region database. The National Institute of Allergy and Infectious Diseases funded the IeDEA initiative to establish regional centers for the collection and harmonization of HIV-related data. This international research consortium has enabled researchers in participating regions to better describe regional trends as well as address unique and evolving research questions in HIV/AIDS currently unanswerable by single cohorts. The Central Africa region database includes data from existing healthcare facilities in the Democratic Republic of the Congo (DRC), where data collection began in 2007, and Cameroon and Burundi, where data collection began in 2008. Approval for this research was granted by the Institutional Review Board (IRB) at the Kinshasa School of Public Health in DRC and RTI International, as well as the national ethics committees in Burundi and Cameroon.

All analyses were performed using SAS 9.1 for Windows [17]. We examined baseline sociodemographic, behavioral, and clinical characteristics of those aged 50+ with those aged 18–49 years using chi-square tests to determine if distributions between the two groups differed. We evaluated differences between countries using chi-square tests to determine if distributions between DRC, Cameroon, and Burundi differed. We also examined whether age was associated with self-reported medication adherence. We defined nonadherence as missed doses (of ART or other HIV-related medications) for two or more consecutive days in the past 30 days. Logistic regression was used to determine if age was associated with medication adherence while controlling for variables such as country, marital status, gender, employment status, heavy drinking, education, clinical stage at enrolment into the IeDEA database, and length of time on ARVs. Included in the model were sociodemographic and clinical characteristics that we hypothesized a priori might affect adherence based on reported associations in the literature in the context of sub-Saharan Africa [18–20] while also considering completeness of data in the IeDEA Central Africa database.

As of June 2011, there were 18,839 adults enrolled in HIV care in the IeDEA Central Africa region database and 2,819 (15%) were 50 years old or older (Table 1). The majority of adults (N = 10,647) were from DRC, 5,835 were from Cameroon, and 2,357 were from Burundi. Of adults aged 50+, the mean age in both DRC and Cameroon was 55 years (median 54 years) and 56 years in Burundi (median 55 years). Those aged 50+ were more evenly distributed between women and men (56% versus 44%, resp.) as compared to those aged 18–49 (71% versus 29%, resp.) (P < 0.05). Approximately 20% of both groups reported heavy drinking, defined as three or more alcoholic drinks per day on average. Fifteen percent of this large cohort of HIV-infected adults were 50 years old or older. Though older adults were more likely to report no formal education than their younger counterparts, they did not seem to be living with fewer amenities as per the socioeconomic variables examined in this study: having a paid profession, access to electricity, and running water in the home. We found that older adults were more likely to be adherent to their medications than their younger counterparts. In terms of other predictors of adherence, we found that adults who were not heavy drinkers reported better adherence as compared to those who reported drinking three or more alcoholic beverages per day. Our results should be considered in light of several study limitations. The adherence data for this study were self-reported and collected during face-to-face interviews with a clinic doctor or nurse, which can lead to social desirability bias and, in turn, inflated adherence estimations [22]. Our baseline data were derived at enrollment into the IeDEA Central Africa database. For many adults, this also corresponded to enrollment into HIV care. Though we were able to determine when ART was started, we were not able to assess how long the patient had been in HIV care before enrolling into the IeDEA database. This is the first study to examine whether there are differences between older adults and their younger counterparts accessing HIV care and treatment in the central Africa region. These results are noteworthy as they provide insight into the sociodemographic, behavioral, and clinical characteristics of HIV-infected older adults in this region. Though we found older adults were more likely to be adherent to their medications than their younger counterparts, further inquiry is needed to better understand factors affecting ART adherence, response to treatment, and survival of older adults receiving HIV care in sub-Saharan Africa. We found that heaving drinking negatively affected medication adherence, which suggests that those reporting heavy alcohol use may benefit from additional adherence counseling.   Source: http://doi.org/10.1155/2012/725713

 

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