Lanièce Isabelle, Ciss Mounirou, Desclaux Alice, Diop Karim, Mbodj Fatou, Ndiaye Barra, Sylla Omar, Delaporte Eric, Ndoye Ibrahima
French Cooperation and National AIDS Program, Dakar, Senegal.
AIDS. 2003 Jul;17 Suppl 3:S103-8. doi: 10.1097/00002030-200317003-00014.
Access to programmes providing highly active antiretroviral therapy (HAART) is recent in Africa. In Senegal, a national initiative was launched in 1998. The capacity of African patients to adhere to complex antiretroviral treatments (ARV) is largely unknown.
We assessed adherence and identified the main reasons for treatment interruption in a prospective observational cohort of patients participating in an ARV access programme in Dakar, Senegal. Adherence was estimated each month on the basis of the patients' stated consumption and on the proportion of the prescribed dose returned unused to the dispensing pharmacy. A total of 158 patients were studied between November 1999 and October 2001.
A cross-section analysis showed that the stated level of adherence was high: on average, over the study period, the patients said they had taken 91% of each monthly dose and that they had taken the full monthly dose during two-thirds of the months studied. Adherence tended to be better among patients who were required to make little or no contribution to the cost of their treatment, through an appropriate pricing structure. Adherence was also better with efavirenz-containing regimens than with indinavir-containing regimens.
These results show that adherence to HAART can be as high in Africa as that generally observed in industrialized countries, and that the cost and type of drug regimen must be taken into account when designing ARV access programmes for poor communities.
在非洲，获得提供高效抗逆转录病毒疗法（HAART）的项目是最近才有的事。在塞内加尔，1998年发起了一项全国性倡议。非洲患者坚持复杂抗逆转录病毒治疗（ARV）的能力在很大程度上尚不清楚。
我们在塞内加尔达喀尔参与ARV获取项目的患者前瞻性观察队列中评估了依从性，并确定了治疗中断的主要原因。每月根据患者自述的用药量以及未使用而退回配药药房的规定剂量比例来估算依从性。1999年11月至2001年10月期间共研究了158名患者。
横断面分析显示，自述的依从水平较高：在研究期间，患者平均表示他们服用了每月剂量的91%，并且在三分之二的研究月份中服用了全月剂量。通过适当的定价结构，那些治疗费用很少或无需自付的患者依从性往往更好。含依非韦伦的治疗方案的依从性也优于含茚地那韦的治疗方案。
这些结果表明，非洲对HAART的依从性可以与工业化国家普遍观察到的依从性一样高，并且在为贫困社区设计ARV获取项目时，必须考虑药物治疗方案的成本和类型。
