Antiretroviral adherence and treatment outcomes among patients living with HIV at an Indonesian HIV clinic: a cross-sectional study
Main Article Content
Keywords
antiretroviral agents, CD4 count, HIV, Indonesia, medication adherence, viral load
Abstract
Objective: This study assessed antiretroviral adherence and treatment outcomes among outpatients with human immunodeficiency virus (HIV). Methods: A cross-sectional study was performed on patients with HIV over 18 years old receiving antiretroviral therapy for at least six months at an Indonesian clinic, from January to March 2021. The previously validated self-reported adherence questionnaire was used to recall antiretroviral use. Viral load and CD4 were indicators of treatment outcomes. Binary logistic regression was used to explore factors associated with nonadherence and poor treatment outcomes. Results: Ninety-five patients were included in the study (male 70.5%, median [interquartile range, IQR] age 35 [29–42] years, and median [IQR] treatment duration 29 [15–49] months). Adherence greater than 95% was observed in 89.5%, 88.4%, 95.8% of the patients in the past week, month, and three months, respectively. Patients with secondary education or lower were associated with low adherence (adjusted odds ratio, aOR: 7.73, 95%CI: 1.12– 53.19). Viral suppression and improved CD4 were observed in 83.2% and 68.4% of the patients, respectively. Taking non-nucleoside reverse transcriptase inhibitors (NNRTIs)-based regimen was associated with viral suppression (aOR: 0.01, 95%CI: 0.00–0.14) as well as high CD4 count (aOR: 0.16, 95%CI: 0.03– 0.83). Being diagnosed with stage 4 of HIV (aOR: 72.38, 95%CI: 3.11–1687.28) and having adherence of 95% or lower (aOR: 68.84, 95%CI: 4.86–974.89) were associated with non-suppressed viral load, and having HIV stage 3 (aOR: 7.81, 95%CI: 1.26–48.40) or 4 (aOR: 26.15, 95%CI: 3.42–200.10) at diagnosis was associated with low CD4. Conclusion: Rates of self-reported adherence and treatment outcomes were high. Secondary education or lower was a predictor of low adherence. Using NNRTIs-based therapy was associated with good treatment outcomes; meanwhile, stage 3 or 4 of HIV at diagnosis and low adherence were predictors of poor outcomes. Therefore, strategies to improve adherence and treatment outcomes are warranted.
References
2. Ministry of Health of the Republic of Indonesia. Laporan Perkembangan HIV AIDS Dan Penyakit Menular Seksual Triwulan IV Tahun 2020 (Quarterly Report on HIV, AIDS, and Sexually-Transmitted Infections in Indonesia, 4th). Jakarta; 2021.
3. Bezabhe WM, Chalmers L, Bereznicki LR, et al. Adherence to antiretroviral therapy and virologic failure: a meta-analysis. Medicine (Baltimore). 2016;95(15). https://doi.org/10.1097/md.0000000000003361
4. Anude CJ, Eze E, Onyegbutulem HC, et al. Immuno-virologic outcomes and immuno-virologic discordance among adults alive and on anti-retroviral therapy at 12 months in Nigeria. BMC Infect Dis. 2013;13:113. https://doi.org/10.1186/1471-2334-13- 113
5. Sikazwe I, Eshun-Wilson I, Sikombe K, et al. Retention and viral suppression in a cohort of HIV patients on antiretroviral therapy in Zambia: Regionally representative estimates using a multistage-sampling-based approach. PLoS Med. 2019;16(5):e1002811. https://doi.org/10.1371/journal.pmed.1002811
6. Lailulo Y, Kitenge M, Jaffer S, et al. Factors associated with antiretroviral treatment failure among people living with HIV on antiretroviral therapy in resource-poor settings: a systematic review and metaanalysis. Syst Rev. 2020;9(1):1-17. https://doi. org/10.1186/s13643-020-01524-1
7. Syed IA, Sulaiman SAS, Hassali MA, et al. Factors associated with poor CD4 and viral load outcomes in patients with HIV/AIDS. J Med Virol. 2016;88(5):790-797. https://doi.org/10.1002/jmv.24389
8. Joseph Davey D, Abrahams Z, Feinberg M, et al. Factors associated with recent unsuppressed viral load in HIV-1-infected patients in care on first-line antiretroviral therapy in South Africa. Int J STD AIDS. 2018;29(6):603-610. https://doi. org/10.1177/0956462417748859
9. Rangarajan S, Colby DJ, Giang LT, et al. Factors associated with HIV viral load suppression on antiretroviral therapy in Vietnam. J Virus Erad. 2016;2(2):94-101. https://doi.org/10.1016/s2055-6640(20)30466-0
10. Joao EC, Gouvêa MI, Menezes JA, et al. Factors associated with viral load suppression in HIV-infected pregnant women in Rio de Janeiro, Brazil. Int J STD AIDS. 2012;23(1):44-47. https://doi.org/10.1258/ijsa.2011.010545
11. Wang X, Ji X. Sample size estimation in clinical research from randomized controlled trials to observational studies. Chest. 2020;158(1):S12-S20. https://doi.org/10.1016/j.chest.2020.03.010
12. Muñoz-Moreno JA, Fumaz CR, Ferrer MJ, et al. Assessing self-reported adherence to HIV therapy by questionnaire : the SERAD (Self-Reported Adherence) study. AIDS Res Hum Retroviruses. 2007;23(10):1166-1175. https://doi.org/10.1089/aid.2006.0120
13. Ministry of Health of the Republic of Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/ Menkes/90/2019 Tentang Pedoman Nasional Pelayanan Kedokteran Tata Laksana HIV (Decree of the Minister of Health No. HK.01.07/Menkes/90/2019 on the National Guideline of HIV Medical Care). Jakarta; 2019.
14. von Elm E, Altman DG, Egger M, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573-577. https://doi.org/10.7326/0003- 4819-147-8-200710160-00010
15. Wasti SP, Simkhada P, Randall J, et al. Factors influencing adherence to antiretroviral treatment in Nepal: A mixed-methods study. PLoS One. 2012;7(5):1-11. https://doi.org/10.1371/journal.pone.0035547
16. Weaver ERN, Pane M, Wandra T, et al. Factors that influence adherence to antiretroviral treatment in an urban population, Jakarta, Indonesia. PLoS One. 2014;9(9):e107543. https://doi.org/10.1371/journal.pone.0107543
17. Januraga PP, Reekie J, Mulyani T, et al. The cascade of HIV care among key populations in Indonesia: a prospective cohort study. Lancet HIV. 2018;5:e560-568. https://doi.org/10.1016/S2352-3018(18)30148-6
18. Sauceda JA, Neilands TB, Johnson MO, et al. An update on the Barriers to Adherence and a Definition of Self-Report Nonadherence Given Advancements in Antiretroviral Therapy (ART). AIDS Behav. 2018;22(3):939-947. https://doi.org/10.1007/ s10461-017-1759-9
19. Barfod TS, Sørensen HT, Nielsen H, et al. “Simply forgot” is the most frequently stated reason for missed doses of HAART irrespective of degree of adherence. HIV Med. 2006;7(5):285-290. https://doi.org/10.1111/j.1468-1293.2006.00387.x
20. Li JZ, Paredes R, Ribaudo HJ, et al. Relationship between minority nonnucleoside reverse transcriptase inhibitor resistance mutations, adherence, and the risk of virologic failure. AIDS. 2012;26(2):185-192. https://doi.org/10.1097/ QAD.0b013e32834e9d7d
21. Altice F, Evuarherhe O, Shina S, et al. Adherence to HIV treatment regimens: systematic literature review and meta-analysis. Patient Prefer Adherence. 2019;13:475-490. https://doi.org/10.2147/PPA.S192735
22. World Health Organization. Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach. Geneva; 2016. https://doi.org/10.1016/j.jped.2014.04.007
23. Limmade Y, Fransisca L, Rodriguez-Fernandez R, et al. HIV treatment outcomes following antiretroviral therapy initiation and monitoring: A workplace program in Papua, Indonesia. PLoS One. 2019;14(2):e0212432. https://doi.org/10.1371/journal. pone.0212432
24. Marcellin F, Spire B, Carrieri MP, et al. Assessing adherence to antiretroviral therapy in randomized HIV clinical trials: A reviewof currently used methods. Expert Rev Anti Infect Ther. 2013;11(3):239-250. https://doi.org/10.1586/eri.13.8
25. Almeida-Brasil CC, Moodie EEM, Cardoso TS, et al. Comparison of the predictive performance of adherence measures for virologic failure detection in people living with HIV: a systematic review and pairwise meta-analysis. AIDS Care - Psychol Socio- Medical Asp AIDS/HIV. 2019;31(6):647-659. https://doi.org/10.1080/09540121.2018.1554241
26. Kaufman AS, Morrison A. Patterns of non-adherence to oral antiretroviral medication: Frequencies of consecutively missed doses. Patient Prefer Adherence. 2019;13:389-394. https://doi.org/10.2147/PPA.S192153
27. Izzah Z, Zijp TR, Åberg C, et al. Electronic smart blister packages to monitor and support medication adherence: a usability study. Patient Prefer Adherence. 2022;16:2543-2558. https://doi.org/https://doi.org/10.2147/PPA.S374685
28. Zijp TR, Izzah Z, Åberg C, et al. Clinical value of emerging bioanalytical methods for drug measurements: a scoping review of their applicability for medication adherence and therapeutic drug monitoring. Drugs. 2021;81(17):1983-2002. https://doi. org/10.1007/S40265-021-01618-7