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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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OUTLINE

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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


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OUTLINE

  • Context

  • Methods

    • Study design

    • Population and sample

    • Data collection

    • Data analysis

  • Results

  • Discussion and conclusion


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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


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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%


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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


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PLWHIV under ART end of 2004 to T1-2006


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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


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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


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Study aim

  • Describe the prevalence of adherence

  • Identify potential determinants of adherence


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Methods


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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


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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


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“Individual” factors

  • Socio-economic

    • Revenue

    • Education

    • Occupation

    • Household attributes

  • Demographics

    • Age

    • Gender

    • Marital status

  • Knowledge of treatment


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Relational factors

  • Having a regular partner

  • Number of children

  • Number of people you provide for

  • Serostatus notification

    • To partner

    • To surroundings


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Treatment regimen

  • Pill burden (number of pills/day)

  • Complexity of schedule (food restrictions)

  • Months on treatment

  • Side effects


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Treatment regimen: Setting

  • Clinical management

  • Community setting

  • Hospital setting

  • Time/distance to appointment


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Results


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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


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Adherence is related to clinical outcomeWeight loss

p≤0.001


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Adherence is related to clinical outcomePatients with OI

p=0.034


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Individual factors associated with adherence:

  • Muslim religion, but confounded ??

  • Shaped relationship between adherence and income?


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Facilitating factors and adherenceRelational Characteristics

Having children is associated with better adherence

Having a regular sex partner is associated with a better adherence


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Facilitating factors and adherence:Influence of the treatment regimen


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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


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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


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Acknowledgements


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