ABSTRACT

Objective: To identify factors associated with antiretroviral therapy (ART) adherence in order to guide the development of strategies to improve the situation.

Design and Methods: A cross-sectional survey was conducted with people living with HIV (PLHIV) who receive services from non-governmental organisations affiliated to the Caribbean Regional Network of People Living with HIV/AIDS (CRN+) in Antigua and Barbuda, Grenada and Trinidad and Tobago.  PLHIV from CRN+ traced potential participants, administered informed consent procedures and carried out structured interviews.  The main outcome measure was 95% to 100% adherence over the past seven days. Multiple logistic regression was conducted to identify associations with demographic characteristics, psychological status, health and support service use, sexual behaviour and substance abuse.

Results: Of 394 respondents, 69.5% were currently taking ART.  Of these, 70.1% took 95% to 100% of their prescribed pills.  One in 20 took more pills than prescribed, all of whom were prescribed fewer or equal to the median pill number.  Factors independently associated with adherence were use of a counselling service (OR 3.20; 95% CI 1.55, 6.61), revelation of HIV status without consent (OR 2.31; 95% CI 1.13, 4.74), alcohol consumption (OR 0.47; 95% CI 0.23, 0.96) and side effects (OR 0.32; 95% CI 0.15, 0.68). Drug resistance to ART was reported by 6% of users.

Conclusion: Improvements in ART adherence may be achieved by counselling, focussed attention to alcohol users and developing drugs with reduced side effects.  Such measures are critical to maintain PLHIV quality of life gains and prevent the proliferation of drug resistant HIV strains.