Adherence to antiretroviral treatment in HIV-positive patients in the Cameroon context: promoting the use of medication reminder methods.

OBJECTIVES

Antiretroviral treatment (ART) scale-up in sub-Saharan Africa has made it possible to investigate the maintenance of adherence to HIV medications. We describe here adherence to ART and identify its correlates in the Cameroonian context.

DESIGN

Prospective cohort study in 9 rural district hospitals.

METHODS

A mixed logistic regression model was used to identify factors associated with adherence to ART in 401 patients with data prospectively collected on adherence.

RESULTS

Although 73% of patients were adherent after the first month on ART, this proportion decreased to 61% after 24 months. After adjustment for known factors of adherence to ART (such as knowledge, motivation and side-effects), patients who reported willingness to start ART before initiation, those who were satisfied with information provided by their physicians, and those who implemented reminder methods for ART intake {eg, using an alarm clock, mobile phone, or watch [odds ratio (95% confidence interval)] = 2.45 (1.58 to 3.79), but also the help of a relative to remind them or other methods} were more likely to be adherent to ART.

CONCLUSIONS

Besides highlighting some correlates already known to have an impact on adherence to ART, our findings also underline the need to reinforce the counseling component of follow-up through innovative methods. Accordingly, training and implementation research should encourage the use of medication reminder methods, such as mobile phones, to assure adherence over time and improve long-term response to ART.