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Email this article Long-term adherence to antiretroviral therapy in Georgia
Abstract
Background: We sought to evaluate adherence to antiretroviral therapy (ART) in the country of Georgia, where the HIV epidemic is largely driven by injection drug use (IDU).
Methods: Retrospective cohort including adult patients initiating ART at four countrywide clinics from January 2009 through June 2011. Adherence was measured in 6-month intervals based on medication refill compliance, which was measured as number of days medication was dispensed divided by days between prescription fills multiplied by 100%. Patients with >90% medication coverage were considered adherent.
Results: Of 569 patients included 72% were males and 55% had history of IDU. The median age at ART initiation was 38 years. The majority of patients (77%) were started on an efavirenz based regimen. More than 75% of patients were adherent in each 6-month period and the proportion of adherent patients did not vary significantly over time (p=0.98). Overall, 182 (32%) patients had at least one episode of non-adherence. In multivariate analysis, history of IDU was associated with an episode of non-adherence (adjusted risk ratio (aRR) 1.51, 95% CI: 1.15-1.98). A total of 412 (72%) patients achieved viral suppression after the first 6 months of ART. Predictors of failure to reach viral suppression were levels of adherence <80% (aRR 3.68 95% CI: 2.86-4.74) and between 80-90% (aRR 2.28, 95% CI: 1.57-3.30). History of IDU was also significantly associated with viremia (aRR1.41, 95% CI: 1.08-1.86).
Conclusions: The majority of patients maintained high levels of adherence over time. Additional efforts are needed to improve adherence and virologic outcomes in persons with history of IDU.
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