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Antiretroviral Adherence in Rural Zambia: The First Year of Treatment Availability

We conducted a retrospective chart review of antiretroviral therapy (ART) clinic patients treated during the first 12 months after clinics opened in rural Zambia and assessed adherence based on clinic attendance, patient report, and staff assessment. We identified 255 eligible patients (mean age, 39.7 years; 44.3% male; 56.5% married; and 45.5% with only primary school education). Twenty percent had partners known to be HIV positive. Twenty percent were widowed. Thirty-seven percent had disclosed their HIV status to their spouse. Disclosure was less likely among women (27.5% versus 49.6%, P = 0.0005); 36.5% had "clinic buddies" to provide adherence support. Adherence rates were good for 59.2%. Disclosure of HIV status to ones’ spouse (P = 0.047), knowing spouses’ HIV status (P = 0.02), and having a clinic buddy (P = 0.01) were associated with good adherence. Social support is a key patient-level resource impacting ART adherence in rural Zambia. Limited spousal disclosure affects women more than men. Clinic buddies are associated with better adherence.

Received August 18, 2008. Accepted for publication December 30, 2008.

Acknowledgments: RAAZ Study Team: Principal Investigator—Gretchen L. Birbeck, Michigan State University, Associate Professor and Director, International Neurologic and Psychiatric Epidemiology Program, East Lansing, MI, and Chikankata Health Services, Mazabuka, Zambia; Michelle P. Kvalsund, Michigan State University, College Osteopathic Medicine and Department of Epidemiology, Senior Research Assistant and Trainer; Peter Byers, Michigan State University, College of Human Medicine, Trainer; Jamey Hardesty, Michigan State University, Department of Microbiology, Research Assistant; Natalie Organek, Michigan State University, College of Osteopathic Medicine. External Advisor—Elwyn Chomba, University of Zambia, Consultant, Department of Pediatric and Child Health, Lusaka, Zambia. Chikankata Health Services—Richard Bradbury, Administrator; Trevor Kaile, Chief Medical Officer; Charles Mang’ombe, Senior Clinical Officer and Program Coordinator; Gamaliel Misago, Senior Medical Officer; Fridah Kabwenda, Research Assistant and Assistant Coordinator; Charles Mabeta, Research Assistant; Lutangu Mulolo, Research Assistant. Monze Mission Hospital—Kennedy Malama, Chief Medical Officer; Lillian Simweene, Research Assistant; Stenga Muzabani, Research Assistant. Nakambala Clinic—Roy Silavwe, Research Assistant; Namakau Lisulo, Research Nurse; Margaret Sampa, Research Assistant. N. Organek assisted in technical support, data acquisition and provided a critical review of the manuscript.

Financial support: Funding for this work was provided by the Doris Duke Charitable Foundation through their 2005 Operations Research for AIDS Care and Treatment in Africa (ORACTA) program. The funders did not participate in or direct the design of this work or development of this manuscript.

Dislosure: None of the authors had any conflicts of interest.

^* Address correspondence to Gretchen L. Birbeck, 324 West Fee Hall, East Lansing, MI 48824. E-mail: Gretchen.Birbeck{at}ht.msu.edu

Note: The appendix "Inter-rater agreement on abstraction quality assessment" appears online at www.ajtmh.org.

Authors’ addresses: Gretchen L. Birbeck, Michigan State University, PO Box 670008, 324 West Fee Hall, East Lansing, MI 48824, Tel: 517-884-0277 or 517-884-0275, E-mail: birbeck{at}msu.edu. Elwyn Chomba, UNZA Department of Pediatrics & Child Health, PO Box 31210, Lusaka, Zambia, Tel: 260-1-254655, Fax: 260-1-291607, E-mail: echomba{at}zamnet.zm. Michelle Kvalsund, 324 West Fee Hall, East Lansing, MI 48824, Tel: 517-884-0276, Fax: 517-884-0275, E-mail: powellmi{at}msu.edu. Richard Bradbury, Chikankata Health Services, Private Bag S2, Mazabuka, Zambia, Cell: 260-097-703199, Fax: 260-32-35765, E-mail: rbradbury{at}chikankata.org.zm. Charles Mang’ombe, Senior Clinical Officer, Chikankata Health Services, Private Bag S2, Mazabuka, Zambia, Cell: 260-097-851053, Fax: 260-32-35765, E-mail: cmangombe{at}chikankata.org.zm. Kennedy Malama, PO Box 660029, Monze, Zambia, Tel: 260-32-50142, Fax: 260-32-50804, E-mail: monzehos{at}zamtel.zm. Trevor Kaile, Chikankata Health Services, Chief Medical Officer, Private Bag S2, Mazabuka, Zambia, Cell: 260-095-752291, Fax: 260-32-35765, E-mail: tkaile89{at}yahoo.co.uk. Peter A. Byers, Michigan State University College of Human Medicine, 324 West Fee Hall, East Lansing, MI 48824, Tel: 517-884-0276, Fax: 517-884-0275, E-mail: byerspet{at}msu.edu. Natalie Organek, E-mail: Natalie.Organek{at}hc.msu.edu.