African HIV Drug Adherence Beats U.S.

Finding That Sub-Saharan Africans Better at Taking Anti-HIV Drugs Goes Against Assumption

Medically Reviewed by Louise Chang, MD on August 09, 2006
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Aug. 9, 2006 -- Sub-Saharan Africans with HIV are more likely to take their drugs as directed than are North Americans, according to a new study.

Researchers examining 58 studies on adherence to HIV drugs found an estimated 77% of sub-Saharan Africans with HIV adhered to the recommended drug regimen, compared with 55% of North American patients.

HIV drug therapy, also referred to as anti-retroviral therapy (ART), has improved the health of millions who would have otherwise died from AIDS. But treatment effectiveness depends on adhering to the regimen, which is complicated and includes dietary restrictions, varying drug dosing schedules, and side effects.

The results, published in JAMA, The Journal of the American Medical Association, challenge the notion that HIV-positive patients in sub-Saharan Africa would be less likely to adhere to complicated HIV regimens because they are poor or lack formal education.

"This review contradicts a historical anticipation of poor adherence by Africans to antiretroviral regimens that was offered as a rationale to delay providing these therapies," says researcher Edward Mills, PhD, MSc, director of the Centre for International Health and Human Rights Studies at the University of California, San Francisco, in a news release.

"If one had considered adherence simply on the basis of evidence, sub-Saharan Africans would have had access to these life-saving therapies earlier," says Mills.

Sub-Saharan Africa represents 10% of the world's population, but accounts for 77% of women with HIV, 79% of AIDS deaths, and 92% of the world's AIDS orphans.

Drug Adherence in Africa

In their analysis, researchers gathered information on ART adherence from 31 studies in North America that included more than 17,000 people with HIV, and 27 sub-Saharan African studies involving more than 12,000 HIV-positive people.

Seventy-one percent of the North American studies used patient self-reporting to measure adherence to anti-HIV drug regimens; 66% of the African studies used the same method.

The results showed 55% of North American HIV patients adequately followed the ART regimen, compared with 77% of those in sub-Saharan Africa.

Problems adhering to the ART regimen among North Americans were linked to poor patient-doctor relationships, untreated depressiondepression, substance abuse, and other factors common among the poor in North America but not poverty itself.

Meanwhile, problems with drug adherence in sub-Saharan Africa were more directly linked to poverty, such as a lack of access to food, drugs, or health care providers.

"Not all poverty is the same; poverty in resource-limited settings presents a different set of challenges than poverty in the U.S.," says researcher David R. Bangsberg, MD, MPH, associate professor of medicine at the University of California, San Francisco, in the release.

"Missed doses among the poor in resource-limited settings is less about neglected doses due to complex behavioral and social problems and is more about structural barriers to reliable medication access," Bangsberg says.

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SOURCES: Mills, E. Jama, The Journal of the American Medical Association, Aug. 9, 2006; vol 296: pp 679-690. News release, American Medical Association. News release, University of California, San Francisco.
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