Antiretroviral therapy (ART) adherence and correlates to nonadherence among people on ART in Estonia

Abstract

There are little data on antiretroviral therapy (ART) adherence among patients in Eastern Europe, despite the high incidence of HIV infection and the growing number of HIV-infected individuals who are being prescribed ART. The aim of this study was to measure rates of adherence to ART and factors associated with nonadherence among patients receiving care at an outpatient HIV clinic in Estonia. The study was based on cross-sectional data from a convenience sample of 144 patients receiving outpatient HIV care. Data were obtained via interviewer-administered surveys and data abstraction from clinical records. Adherence was measured from a 3-day patient self-report. Among 144 participants (mean age 33.8 years), two-thirds (63%) had been infected with HIV through intravenous drug use. Most (74%) were co-infected with hepatitis C (HCV). Perfect adherence over the last 3 days was commonly reported (88% [95% CI 81–92%]) with nonperfect adherence associated with greater concerns about the potential adverse consequences of taking ART (adjusted odds ratio [AOR] 4.8, 95% CI 1.2–34.0) and average (versus good/very good) self-reported health status (AOR 4.7, 95% CI 1.2–31.4). Self-reported ART adherence in this sample of Estonian HIV-positive patients in clinical care was similar to rates observed in Western Europe and other developed countries. Results suggest that adherence education and support may be most helpful if they specifically target the development of positive beliefs, reduction of negative expectancies towards ART.

Keywords:

• ART
• HAART
• adherence
• 3-day recall
• nonadherence
• Estonia

Acknowledgements

We thank the study team members Anne Junolainen and Kristiina Šreiner at the East-Viru Central Hospital and the study participants for their significant contributions, and Esa Läära for his valuable comments on analysis of the data. AU, KTL, and AS designed the study and planned the analysis for the manuscript. KTL was responsible for and supervised the data collection in the study. JŠ, SS, and JK were responsible for the data collection. MK conducted the statistical analysis. AU wrote the first draft of the manuscript to which KRA and JD contributed. All authors contributed to revising the manuscript and have approved the final manuscript. The study was supported by the Tibotec Circo Comm. Va. (REACH Initiative: Research and Education in HIV/AIDS for Resource-Poor Countries); grant SF0180060s09 from the Estonian Ministry of Education and Research; the New York State International Training and Research Program grant D43TW000233 from the National Institutes of Health/Fogarty International Center and the National Institute on Drug Abuse (NIDA) (USA).