@article{d72bf302986a488ca2ce1f35f1dac333,
title = "Predictors of Treatment Adherence and Virological Failure Among People Living with HIV Receiving Antiretroviral Therapy in a South African Rural Community: A Sub-study of the ITREMA Randomised Clinical Trial",
abstract = "A large proportion of people living with HIV (PLHIV) in sub-Saharan Africa reside in rural areas. Knowledge of enablers and barriers of adherence to antiretroviral treatment (ART) in these populations is limited. We conducted a cohort study of 501 adult PLHIV on ART at a rural South African treatment facility as a sub-study of a clinical trial (ClinicalTrials.gov NCT03357588). Socio-economic, psychosocial and behavioral characteristics were assessed as covariates of self-reported adherence difficulties, suboptimal pill count adherence and virological failure during 96 weeks of follow-up. Male gender was an independent risk factor for all outcomes. Food insecurity was associated with virological failure in males. Depressive symptoms were independently associated with virological failure in both males and females. Household income and task-oriented coping score were protective against suboptimal pill-count adherence. These results underscore the impact of low household income, food insecurity and depression on outcomes of ART in rural settings and confirm other previously described risk factors. Recognition of these factors and targeted adherence support strategies may improve patient health and treatment outcomes.",
keywords = "Adherence, Antiretroviral therapy, Depression, Pill count, South Africa, Virological failure",
author = "Gumede, {Siphamandla B.} and Wensing, {Annemarie M.J.} and Lalla-Edward, {Samanta T.} and {de Wit}, {John B.F.} and {Francois Venter}, {W. D.} and Tempelman, {Hugo A.} and Hermans, {Lucas E.}",
note = "Funding Information: Open access funding provided by University of the Witwatersrand. SBG is funded by the Carnegie Corporation of New York (Grant No. G-19-57145), The Swedish International Development Cooperation Agency (Grant No. 54100113), Uppsala Monitoring Centre and the DELTAS Africa Initiative (Grant No. 107768/Z/15/Z). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS){\textquoteright}s Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa{\textquoteright}s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust (UK) and the UK government. The statements made and views expressed are solely the responsibility of the Fellow. WDFV and STL-E are supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health (Award Number UG3HL156388). The content of this publication is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funding Information: We would like to thank the ITREMA participants and investigators. The ITREMA trial was supported by the Netherlands Organisation for Health Research and Development (ZonMW) and NWO-WOTRO Science for Global Development (Grant No: 205300004) and the ZONMW VIMP (Grant No: 2053000041). This sub-study was supported by the Consortium for Advanced Research Training in Africa (CARTA). CARTA is jointly led by the African Population and Health Research Center and the University of the Witwatersrand. The statements and views made in this article are solely the responsibility of the authors. Funding Information: AMJW reports grants or contracts from an Investigator-initiated grant from Gilead global for the study of HIV Integrase resistance (Rosetta) (pending, grant to institution), Health Holland ICD-ICK4HIVCure (paid to institution), and ZonMW (Dutch government, paid to institution); consulting fees from Gilead, ViiV/GSK, and Janssen (paid to institution); payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Virology Education and the Southern African HIV Clinicians Society (paid to institution). AMJW Serves as a CEO for the European Society for Antiviral Research (ESAR) (unpaid), as governing Board member European AIDS Clinical Society, Chair of the European AIDS conference 2021 (unpaid, travel expenses paid to Institution), Member of the WHO Resnet (unpaid, travel expenses paid to Institution), Chair of the IAS-USA HIV drug resistance panel (unpaid), and as an Organizing Committee member of the European HIV and Hepatitis Meeting (unpaid, travel expenses paid to Institution). WDFV received funding for the ADVANCE RCT through his institution from UNITAID, USAID, and SAMRC, and received study drug from ViiV Healthcare and Gilead Sciences. WDFV also reports funding for his unit from the Bill and Melinda Gates, Foundation, National Institutes for Health, UNITAID, Foundation for Innovative New Diagnostics (FIND) and the Children{\textquoteright}s Investment Fund Foundation (CIFF), and received drug donations from Merck and J&J Sciences for investigator-led clinical studies. The unit leads investigator-led studies that receive financial support from Merck and ViiV and is involved in commercial drug studies for Merck. The unit performs evaluations of diagnostic devices for multiple biotech companies. WDFV. Also receives honoraria for educational talks and advisory board membership for Gilead, ViiV, Mylan, Merck, Adcock-Ingram, Aspen, Abbott, Roche, J&J, Sanofi and Virology Education; participates on DSMB for NIH International; is currently an unpaid board member for Dira Sengwe and was an unpaid board member for SAHCS. None of the ADVANCE RCT funders were involved in the design, execution, or analysis of this study. All other authors report no potential conflicts. Publisher Copyright: {\textcopyright} 2023, The Author(s).",
year = "2023",
month = dec,
doi = "10.1007/s10461-023-04103-2",
language = "English",
volume = "27",
pages = "3863--3885",
journal = "AIDS and Behavior",
issn = "1090-7165",
publisher = "Springer New York",
number = "12",
}