Adherence To Antiretroviral Therapy And Its Impact On Clinical And Immunologic Outcomes
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Date
2015-11-03
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Abstract
Adherence to highly active antiretroviral therapy (HAART) has been associated with
achieving success in virologic suppression, CD4 cell recovery, and improved patient
well-being. Most of these researches reporting on the impact of adherence to
HAART on treatment outcomes are published works from resource rich setting with
little or no literature from Ghana. This study was therefore conducted to assess the
impact of adherence to HAART on clinical and immunologic outcomes at two
nationally designated HIV treatment centers in Kumasi, Ghana.
The study was a prospective non- randomised study of HIV- infected patients at
Aniwaa medical center and Bomso specialist hospital, private health facilities in the
Kumasi metropolis. The patients were recruited to initiate antiretroviral therapy. A
total of 86 patients were enrolled and 85 completed. Data collection lasted for 1 year
1 month. Patients were assessed for their level of adherence to HAART over a nine
month period during interviews and pill counts. Patients who took ≥95% of their
medication were classified as adherent whiles those who took ≤ 95% of their regimen
were described as non- adherent. Data regarding clinical outcomes were collected at
baseline, 3 month, 6 month and 9
th
month, whereas data on immunologic outcomes
were collected at baseline, 6 month and 9 month respectively. The data obtained was
coded, entered into SPSS version 20.0 and analyzed.
Over 90% of the participants were adherent to their therapy. Common reasons for
missing medications were side effect (44.7%), forgetfulness (42.4%), being away
from home (42.4%). The mean CD4 count at baseline was 235cells/uL, 6
th
month
(394cells/uL) and 9
th
month (469cells/uL). Mean number of opportunistic infections
and signs and symptoms was 3.34 and 4.79 at baseline, 1.56 and 2.03 at 3
rd
month,
v
1.12 and 1.16 at 6
th
month and 1.00 and 1.13 at 9
th
month. Overall physical health of
patients improved from poor at baseline to good at the 9
th
month.
Adherence to HAART was a strong predictor of immune recovery, growth and
clinical progression but adherence was seen not to be the only predictor of treatment
outcomes. Baseline CD4 count was also found to predict outcomes for HIV infected
patients.
The most frequently used ARV in combination therapies was Tenofovir. Majority of
patients in the study were adherent. After the nine months of study, both
immunologic and clinical outcomes of patients significantly improved.
Description
A thesis submitted in partial fulfillment of the requirements for the award of Master of Philosophy in Clinical Pharmacology in the Department Of Pharmacology.