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

    2. OUTLINE • Context • Methods • Study design • Population and sample • Data collection • Data analysis • Results • Discussion and conclusion

    3. 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

    4. 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%

    5. 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

    6. PLWHIV under ART end of 2004 to T1-2006

    7. 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

    8. 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

    9. Study aim • Describe the prevalence of adherence • Identify potential determinants of adherence

    10. Methods

    11. 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

    12. 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

    13. “Individual” factors • Socio-economic • Revenue • Education • Occupation • Household attributes • Demographics • Age • Gender • Marital status • Knowledge of treatment

    14. Relational factors • Having a regular partner • Number of children • Number of people you provide for • Serostatus notification • To partner • To surroundings

    15. Treatment regimen • Pill burden (number of pills/day) • Complexity of schedule (food restrictions) • Months on treatment • Side effects

    16. Treatment regimen: Setting • Clinical management • Community setting • Hospital setting • Time/distance to appointment

    17. Results

    18. 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

    19. Adherence is related to clinical outcomeWeight loss p≤0.001

    20. Adherence is related to clinical outcomePatients with OI p=0.034

    21. Individual factors associated with adherence: • Muslim religion, but confounded ?? • Shaped relationship between adherence and income?

    22. Facilitating factors and adherenceRelational Characteristics Having children is associated with better adherence Having a regular sex partner is associated with a better adherence

    23. Facilitating factors and adherence:Influence of the treatment regimen

    24. 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

    25. 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

    26. Acknowledgements