Long-term adherence to antiretroviral therapy in Georgia

Nikoloz Chkhartishvili, Akaki Abutidze, Natia Dvali, Russell Kempker, Tengiz Tsertsvadze


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.


adherence, antiretroviral therapy, IDU, Eastern Europe, Georgia

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UNAIDS. Prevention Gap Report. Geneva: UNAIDS; 2016.

Liu H, Miller LG, Hays RD, Golin CE, Wu T, Wenger NS, Kaplan AH. Repeated measures longitudinal analyses of HIV virologic response as a function of percent adherence, dose timing, genotypic sensitivity, and other factors. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2006 Mar 1;41(3):315-22.

Sethi AK, Celentano DD, Gange SJ, Moore RD, Gallant JE. Association between adherence to antiretroviral therapy and human immunodeficiency virus drug resistance. Clinical Infectious Diseases. 2003 Oct 15;37(8):1112-8.

Bangsberg DR, Perry S, Charlebois ED, Clark RA, Roberston M, Zolopa AR, Moss A. Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. Aids. 2001 Jun 15;15(9):1181-3.

Hogg RS, Heath K, Bangsberg D, Yip B, Press N, O'shaughnessy MV, Montaner JS. Intermittent use of triple-combination therapy is predictive of mortality at baseline and after 1 year of follow-up. Aids. 2002 May 3;16(7):1051-8.

Mills EJ, Nachega JB, Buchan I, Orbinski J, Attaran A, Singh S, Rachlis B, Wu P, Cooper C, Thabane L, Wilson K. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. Jama. 2006 Aug 9;296(6):679-90.

Ortego C, Huedo-Medina TB, Llorca J, Sevilla L, Santos P, Rodríguez E, Warren MR, Vejo J. Adherence to highly active antiretroviral therapy (HAART): a meta-analysis. AIDS and Behavior. 2011 Oct 1;15(7):1381-96.

Grossberg R, Zhang Y, Gross R. A time-to-prescription-refill measure of antiretroviral adherence predicted changes in viral load in HIV. Journal of clinical epidemiology. 2004 Oct 31;57(10):1107-10.

McNutt LA, Wu C, Xue X, Hafner JP. Estimating the relative risk in cohort studies and clinical trials of common outcomes. American journal of epidemiology. 2003 May 15;157(10):940-3.

Spiegelman D, Hertzmark E. Easy SAS calculations for risk or prevalence ratios and differences. American journal of epidemiology. 2005 Aug 1;162(3):199-200.

Byakika-Tusiime J, Crane J, Oyugi JH, Ragland K, Kawuma A, Musoke P, Bangsberg DR. Longitudinal antiretroviral adherence in HIV+ Ugandan parents and their children initiating HAART in the MTCT-Plus family treatment model: role of depression in declining adherence over time. AIDS and Behavior. 2009 Jun 1;13(1):82-91.

Cambiano V, Lampe FC, Rodger AJ, Smith CJ, Geretti AM, Lodwick RK, Puradiredja DI, Johnson M, Swaden L, Phillips AN. Long-term trends in adherence to antiretroviral therapy from start of HAART. Aids. 2010 May 15;24(8):1153-62.

Hinkin CH, Hardy DJ, Mason KI, Castellon SA, Durvasula RS, Lam MN, Stefaniak M. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS (London, England). 2004 Jan 1;18(Suppl 1):S19.

Golin CE, Liu H, Hays RD, Miller LG, Beck CK, Ickovics J, Kaplan AH, Wenger NS. A prospective study of predictors of adherence to combination antiretroviral medication. Journal of general internal medicine. 2002 Oct 1;17(10):756-65.

O’Neil CR, Palmer AK, Coulter S, O’Brien N, Shen A, Zhang W, Montaner JS, Hogg RS. Factors associated with antiretroviral medication adherence among HIV-positive adults accessing highly active antiretroviral therapy (HAART) in British Columbia, Canada. Journal of the International Association of Physicians in AIDS Care. 2012 Mar;11(2):134-41.

Westergaard RP, Ambrose BK, Mehta SH, Kirk GD. Provider and clinic-level correlates of deferring antiretroviral therapy for people who inject drugs: a survey of North American HIV providers. Journal of the International AIDS Society. 2012 Feb 23;15(1):10.

Bobrova N, Sarang A, Stuikyte R, Lezhentsev K. Obstacles in provision of anti-retroviral treatment to drug users in Central and Eastern Europe and Central Asia: a regional overview. International Journal of Drug Policy. 2007 Aug 31;18(4):313-8.

Sarang A, Rhodes T, Sheon N. Systemic barriers accessing HIV treatment among people who inject drugs in Russia: a qualitative study. Health policy and planning. 2013 Oct 1;28(7):681-91.

Tang MW, Kanki PJ, Shafer RW. A review of the virological efficacy of the 4 World Health Organization–recommended tenofovir-containing regimens for initial HIV therapy. Clinical Infectious Diseases. 2012 Mar 15;54(6):862-75.

Todadze K, Lezhava G. Implementation of drug substitution therapy in Georgia. Central European journal of public health. 2008 Sep 1;16(3):121.


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