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Experience under the TAP: Determinants and experience with adherence in Burkina Faso - PowerPoint PPT Presentation


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Experience under the TAP: Determinants and experience with adherence in Burkina Faso Hospital and Community Sites in Burkina Faso Pascal NIAMBA , Cecile BELOUME . OUTLINE. Context Methods Study design Population and sample Data collection Data analysis Results

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slide1

Experience under the TAP: Determinants and experience with adherence in Burkina Faso Hospital and Community Sites in Burkina Faso Pascal NIAMBA, Cecile BELOUME

outline
OUTLINE
  • Context
  • Methods
    • Study design
    • Population and sample
    • Data collection
    • Data analysis
  • Results
  • Discussion and conclusion
burkina faso
Burkina Faso
  • 274 200 km²
  • 12 802 282 inhabitants (2005)
  • < 15 years: 55%
  • Women :52%
  • PNB 268 USD
  • 46 % of the population is below the poverty line
  • IDH=0,303 en 2000
situation analysis
Situation Analysis
  • Epidemiological Data:
    • Sentinel site surveillance (2004):
      • Prevalence rate 2.4%.
      • Urban sites: 3.4%
      • Rural areas: 1.5%
    • Estimates for 2005 (UNAIDS)
      • Adults living with HIV/AIDS: 135 120
      • HIV/AIDS prevalence rates in adults

(15- 49): 2%

hiv patient care in sub saharan africa the big picture
HIV patient care in Sub-Saharan Africa « the big picture »
  • Dramatic price reductions + new programs → rapid expansion of ARV programs
  • 500 000 people are receiving ARV (UNAIDS “3x5”)
  • Scale-up is accelerating in most countries on the African continent
slide7
HIV patient care in Sub-Saharan Africa « the big picture »Adherence to treatment will become a challenge
  • Adherence determines treatment efficacy
  • Initial pilot studies →high levels of adherence
  • In our initial studies → adherence appears to be inadequate in some sites
  • Few studies on determinants of adherence in Sub-Saharan Africa
slide8
Background study 46/73 patients (63%) non-adherentto ARV therapy in a community-based cohort in Burkina Faso
  • The majority on triple therapy
  • 84% on first HAART regimen
  • 75% on HAART > 6 months

Side effects

Not enough food to

accompany medications

Running out of medication

Circumstantial constraints

19

Depression

15

Forgetting

13

Medication-related

reasons *

10

9

Number of responses

Falling asleep

6

6

4

3

Other §

  • Traoré AA, N.V., Fakoya A, McCarrick P, Dhaliwal M, Tiendrébéogo I, Ilboudo A, Barriers to adherence to ARV therapy in a community-based cohort in Burkina Faso. The XV International AIDS Conference, 2004. Abstract number: WePeB582
study aim
Study aim
  • Describe the prevalence of adherence
  • Identify potential determinants of adherence
methods 1
Methods (1)
  • Study design: cross-sectional study
  • Population: patients >6 months ARV in hospitals and CBO
  • Sample: n=270 (94 men; 176 women)
  • Recruitment sites
    • In Ouagadougou: 1 Hospital and 2 CBO
  • Data collection: Face-to-face interviews with a close-ended questionnaire + chart review
methods 2
Methods (2)
  • Measuring adherence:
  • Patients were considered adherent if they answered “YES” to the following questions
    • “Always” took their ART
    • Took all pills yesterday, the day before yesterday and during the whole week
    • Followed the treatment schedule yesterday, the day before yesterday and during the whole week
    • AND missed < 1 dose in the month
individual factors
“Individual” factors
  • Socio-economic
    • Revenue
    • Education
    • Occupation
    • Household attributes
  • Demographics
    • Age
    • Gender
    • Marital status
  • Knowledge of treatment
relational factors
Relational factors
  • Having a regular partner
  • Number of children
  • Number of people you provide for
  • Serostatus notification
    • To partner
    • To surroundings
treatment regimen
Treatment regimen
  • Pill burden (number of pills/day)
  • Complexity of schedule (food restrictions)
  • Months on treatment
  • Side effects
treatment regimen setting
Treatment regimen: Setting
  • Clinical management
  • Community setting
  • Hospital setting
  • Time/distance to appointment
adherence in hospital vs cbo
Adherencein hospital vs CBO

80

70

CBOs

*

p=0.082

60

Hospitals

57,5

50

Percent (%)

43,8

40

30

20

10

0

Burkina Faso

  • Overall, adherence is inadequate: Only 58.5% (158/270) of patients had complete adherence.
    • Hospitals (64.6%) > CBOs (50.0%) p<0.017
slide21

Individual factors associated with adherence:

  • Muslim religion, but confounded ??
  • Shaped relationship between adherence and income?
facilitating factors and adherence relational characteristics
Facilitating factors and adherenceRelational Characteristics

Having children is associated with better adherence

Having a regular sex partner is associated with a better adherence

preventive behavior and adherence
Preventive behavior and adherence

Only 58%(123/212) used condoms with regular partner at last intercourse

Only 56%(120/212) notified partner about their serostatus

concluding remarks
Concluding remarks
  • Adherence and preventive behaviours are inadequate
  • No clear association between individual factors and adherence
  • Decreasing adherence over time:
    • second year of treatment “high risk” for non-adherence
  • Implications for antiretroviral resistance
  • Need for prospective studies of adherence to treatment AND prevention
ad