Ahmed Ismael, Tefera Fana, Bekele Alemayehu, Ayalew Jemal, Tessema Fasil, Abera Getinet, Ahmed Jelaludin, Mekonnen Alemayehu, Haile Ashenafi, Yohannes Fikerte, Getachew Mirtie, Abdella Saro, Shah Minesh
U.S. Centers for Disease Control and Prevention (CDC), Addis Ababa, Ethiopia.
Centre for Innovative Drug Development & Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, Addis Ababa, Ethiopia.
Sci Rep. 2025 Apr 12;15(1):12666. doi: 10.1038/s41598-025-96631-1.
Despite the success in scaling-up antiretroviral therapy (ART) services in Ethiopia, suboptimal adherence to ART has been an existing challenge. There is a dearth of evidence on the status of adherence to ART following the adoption of test and treat strategy in Ethiopia. This study aimed to investigate on the magnitude of suboptimal adherence and its predictors among patients taking ART. A multicenter prospective cohort study was conducted among adults aged 15 years and above who started ART between March and June 2019 in 39 health facilities (HFs) in Ethiopia. Measurements on sociodemographic, behavioral, and clinical characteristics were taken at baseline and 6- and 12-months following ART initiation. Multivariable logistic regression model using generalized estimating equations was used to identify factors associated with suboptimal adherence. In total, 1229 individuals who started ART were included in the study. The proportion of suboptimal adherence was 8.0% and 7.9% at 6- and 12-months, respectively. Younger age (adjusted odds ratio (AOR) = 2.28 (95% confidence interval (CI) 1.10, 4.74)), being single (AOR = 2.08 (95% CI 1.25, 3.48)), and being a farmer (AOR = 3.21 (95% CI 1.84, 5.61)) were associated with increased risk for suboptimal adherence. Similarly, alcohol intake (AOR = 3.31 (95% CI 2.14, 5.11)), missing clinic appointment (AOR = 5.73 (95% CI 3.76, 8.75)), having opportunistic infections (AOR = 2.86 (95% CI 1.67, 4.88)) and presence of comorbidities (AOR = 3.51 (95% CI 1.89, 6.53)) were associated with higher risk for suboptimal adherence. We observed lower rate of suboptimal adherence to ART following the implementation of test and treat strategy in Ethiopia. Various sociodemographic, clinical, and behavioral factors were found to be independent predictors of suboptimal adherence. The findings highlight the importance of person-centered adherence support based on individual characteristics.
尽管埃塞俄比亚在扩大抗逆转录病毒治疗（ART）服务方面取得了成功，但ART依从性欠佳一直是一个现存的挑战。关于埃塞俄比亚采用检测和治疗策略后ART依从性状况的证据不足。本研究旨在调查接受ART治疗的患者中欠佳依从性的程度及其预测因素。在埃塞俄比亚39个医疗机构（HFs）中，对2019年3月至6月开始接受ART治疗的15岁及以上成年人进行了一项多中心前瞻性队列研究。在基线以及ART开始后的6个月和12个月时，对社会人口学、行为和临床特征进行了测量。使用广义估计方程的多变量逻辑回归模型来确定与欠佳依从性相关的因素。该研究共纳入了1229名开始接受ART治疗的个体。6个月和12个月时欠佳依从性的比例分别为8.0%和7.9%。年龄较小（调整后的优势比（AOR）=2.28（95%置信区间（CI）1.10，4.74））、单身（AOR=2.08（95%CI 1.25，3.48））以及是农民（AOR=3.21（95%CI 1.84，5.61））与欠佳依从性风险增加相关。同样，饮酒（AOR=3.31（95%CI 2.14，5.11））、错过门诊预约（AOR=5.73（95%CI 3.76，8.75））、患有机会性感染（AOR=2.86（95%CI 1.67，4.88））以及存在合并症（AOR=3.51（95%CI 1.89，6.53））与欠佳依从性风险较高相关。我们观察到埃塞俄比亚实施检测和治疗策略后ART欠佳依从性的发生率较低。发现各种社会人口学、临床和行为因素是欠佳依从性的独立预测因素。研究结果突出了基于个体特征的以患者为中心的依从性支持的重要性。
