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Neuropsychiatric and Socioeconomic Status Impact Antiretroviral Adherence and Mortality in Rural Zambia

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  • Michigan State University, International Neurologic and Psychiatric Epidemiology Program, East Lansing, Michigan; Vanderbilt University, Department of Neurology, Nashville, Tennessee; Eastern Virginia Medical School, Department of Emergency Medicine, Norfolk, Virginia; Research and Development Unit, The Salvation Army, London, United Kingdom; Chikankata Hospital, Private Bag S2, Mazabuka, Zambia; Nakambala Clinic, Zambia Sugar PLC, Mazabuka, Zambia; University of Zambia, Department of Pediatrics and Child Health, Lusaka, Zambia; Provincial Health Office, Kabwe, Zambia; USAID/Zambia, Multisectoral office-HIV Prevention, Lusaka, Zambia

We conducted a prospective cohort study of 496 adults starting antiretroviral treatment (ART) to determine the impact of neuropsychiatric symptoms and socioeconomic status on adherence and mortality. Almost 60% had good adherence based upon pharmacy records. Poor adherence was associated with being divorced, poorer, food insecure, and less educated. Longer travel time to clinic, concealing one's human immunodeficiency virus (HIV) status, and experiencing side effects predicted poor adherence. Over a third of the patients had cognitive impairment and poorer cognitive function was also associated with poor adherence. During follow-up (mean 275 days), 20% died—usually within 90 days of starting ART. Neuropsychiatric symptoms, advanced HIV, peripheral neuropathy symptoms, food insecurity, and poverty were associated with death. Neuropsychiatric symptoms, advanced HIV, and poverty remained significant independent predictors of death in a multivariate model adjusting for other significant factors. Social, economic, cognitive, and psychiatric problems impact adherence and survival for people receiving ART in rural Zambia.

Author Notes

*Address correspondence to Gretchen L. Birbeck, #324 West Fee Hall, East Lansing, MI 48824. E-mail: birbeck@msu.edu

Financial support: Funding for this work was provided by the Doris Duke Charitable Foundation through their program for Operational Research for AIDS Care and Treatment in Africa (ORACTA).

Authors' addresses: Gretchen L. Birbeck, Peter A. Byers, and Natalie Organek, Michigan State University, International Neurologic and Psychiatric Epidemiology Program, East Lansing, MI, E-mails: birbeck@msu.edu, light122376@yahoo.com, and organekn@msu.edu. Michelle P. Kvalsund, Vanderbilt University, Department of Neurology, Nashville, TN, E-mail: mkvalsund@gmail.com. Richard Bradbury, Research and Development Unit, The Salvation Army, London, UK, E-mail: Richard.Bradbury@salvationarmy.org.uk. Charles Mang'ombe and Trevor Kaile, Chikankata Health Services, Mazabuka, Zambia, E-mails: mangombe2@yahoo.co.uk and tkaile89@yahoo.co.uk. Alex M. Sinyama, Nakambala Clinic, Zambia Sugar PLC, Mazabuka, Zambia, E-mail: Asinyama@zamsugar.zm. Sylvester S. Sinyangwe, Department of Pediatrics and Child Health, Lusaka, Zambia, E-mail: s_sinyangwe@yahoo.co.uk. Kennedy Malama, Provincial Health Office, Kabwe, Zambia, E-mail: malamakennedy@yahoo.com. Costantine Malama, USAID/Zambia, Multisectoral Office-HIV Prevention, Lusaka, Zambia, E-mail: cmalama@gmail.com.

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