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Failure is not an option: Barriers to HIV treatment adherence in Kampala, Uganda

Gabrielle Bruser1, Ritah Katasi2, Lily Ziyue Zhang3

  • 1Department of Geography, Western University, Social Science Centre, 1151 Richmond St, London, Ontario, N6A 5C2, Canada.

Health & Place
|December 4, 2020
PubMed

Insights

Adherence to combined antiretroviral therapy (cART) in Kampala, Uganda, is unexpectedly better for patients living further from clinics. High income and relationships may increase missed doses, possibly due to stigma.

Area of Science:

  • Public Health
  • Infectious Diseases
  • HIV/AIDS Research

Background:

  • Combined antiretroviral therapy (cART) is crucial for managing HIV-1 infection.
  • Understanding adherence challenges is vital for improving treatment outcomes in resource-limited settings.
  • Stigma remains a significant factor affecting the lives of people living with HIV in Kampala.

Purpose of the Study:

  • To investigate challenges to cART adherence and treatment outcomes in Kampala, Uganda.
  • To identify predictors of treatment adherence and failure among HIV-1 patients.
  • To explore the relationship between socio-demographic factors and cART adherence.

Main Methods:

  • A survey was administered to two cohorts of HIV-1 patients at the Joint Clinical Research Center (JCRC) in Kampala.
  • Cohort I: 93 patients with successful 3-year cART treatment.
  • Cohort II: 56 patients with first-line cART failure within 2 years.

Main Results:

  • Contrary to hypothesis, participants living >2 hours from the clinic were less likely to miss doses (OR=0.33, p<.05).
  • High-income employment (OR=3.82, p<.05) and partnered status (OR=4.28, p<.05) predicted increased missed doses.
  • These adherence patterns may be linked to persistent HIV-related stigma in Kampala.

Conclusions:

  • Distance to treatment facility is not a primary predictor of poor cART adherence in this Kampala cohort.
  • Socio-economic factors like high income and relationship status, alongside stigma, influence cART adherence.
  • Further research into stigma mitigation strategies is needed to improve HIV treatment outcomes.

Keywords:
AdherenceAntiretroviral therapyHIV/AIDSStigmaUganda

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