Suboptimal antiretroviral therapy adherence among HIV-infected adults in Guangzhou, China

Abstract

Despite China's free antiretroviral therapy (ART) program, there are high rates of treatment failure, large sociodemographic disparities in care outcomes and emerging medication resistance. Understanding patient medication adherence behaviors and challenges could inform adherence interventions to maximize the individual and prevention benefits of ART. This study assessed recent nonadherence and treatment interruption among 813 HIV-infected adult outpatients in Guangzhou, China. Participants completed a behavioral survey, underwent chart review, and were tested for syphilis, gonorrhea, and chlamydia. Factors associated with suboptimal adherence were identified using univariate and multivariate logistic regression. Among 721 HIV-infected adults receiving ART, 18.9% reported recent nonadherence (any missed ART in the past four weeks) and 6.8% reported treatment interruption (four or more weeks of missed ART in the past year). Lower education, living alone, alcohol use, and being on ART one to three years were associated with recent nonadherence. Male gender, lower education, and being on ART one to three years were associated with treatment interruption. ART medication adherence interventions are needed in China that include individualized, long-term adherence plans sensitive to patients' educational and economic situations. These interventions should also consider possible gender disparities in treatment outcomes and address the use of alcohol during ART. Successful ART medication adherence interventions in China can inform other international settings that face similar adherence challenges and disparities.

Keywords:

• antiretroviral therapy
• ART
• adherence
• alcohol
• China

Acknowledgments

We would like to thank the nursing staff and Dr Haolan He at the Guangzhou Municipal No. Eight People's Hospital infectious disease outpatient clinic, Dr Xuan Hong, and Dr Cheng Wang at Guangdong Provincial Center for Skin Diseases and STD Control, and Dr Bunnell and Dr Eisele for sharing their questionnaires.

Funding

The study was supported by the UNC Center for AIDS Research [grant number NIH 5P30AI050410–13], the Doris Duke Charitable Foundation International Medical Student Program, an International Research Scientist Developmental Award [grant number NIH 1K01TW008200–01A1]. KE Muessig was supported by an institutional training grant [grant number NIH 5T32AI007001–35].

Additional information

Funding

Funding: The study was supported by the UNC Center for AIDS Research [grant number NIH 5P30AI050410–13], the Doris Duke Charitable Foundation International Medical Student Program, an International Research Scientist Developmental Award [grant number NIH 1K01TW008200–01A1]. KE Muessig was supported by an institutional training grant [grant number NIH 5T32AI007001–35].