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Reference Manager
BibTeX
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Neuropsychiatric and Socioeconomic Status Impact Antiretroviral Adherence and Mortality in Rural Zambia
Gretchen L. Birbeck
Gretchen L. Birbeck
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
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Michelle P. Kvalsund
Michelle P. Kvalsund
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
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Peter A. Byers
Peter A. Byers
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
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Richard Bradbury
Richard Bradbury
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
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Charles Mang'ombe
Charles Mang'ombe
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
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Natalie Organek
Natalie Organek
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
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Trevor Kaile
Trevor Kaile
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
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Alex M. Sinyama
Alex M. Sinyama
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
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Sylvester S. Sinyangwe
Sylvester S. Sinyangwe
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
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Kennedy Malama
Kennedy Malama
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
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Costantine Malama
Costantine Malama
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
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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
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.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Lucas GM, Chaisson RE, Moore RD, 1999. Highly active antiretroviral therapy in a large urban clinic: risk factors for virologic failure and adverse drug reactions. Ann Intern Med 131: 81–87.
-
2.
Nachega JB, Hislop M, Dowdy DW, Chaisson RE, Regensberg L, Maartens G, 2007. Adherence to nonnucleoside reverse transcriptase inhibitor-based HIV therapy and virologic outcomes. Ann Intern Med 146: 564–573.
-
3.
Nachega JB, Stein DM, Lehman DA, Hlatshwayo D, Mothopeng R, Chaisson RE, Karstaedt AS, 2004. Adherence to antiretroviral therapy in HIV-infected adults in Soweto, South Africa. AIDS Res Hum Retroviruses 20: 1053–1056.
-
4.
Coetzee D, Boulle A, Hildebrand K, Asselman V, Van Cutsem G, Goemaere E, 2004. Promoting adherence to antiretroviral therapy: the experience from a primary care setting in Khayelitsha, South Africa. AIDS 18 (Suppl 3): S27–S31.
-
5.
Braitstein P, Brinkhof MW, Dabis F, Schechter M, Boulle A, Miotti P, Wood R, Laurent C, Sprinz E, Seyler C, Bangsberg DR, Balestre E, Sterne JA, May M, Egger M, 2006. Mortality of HIV-1-infected patients in the first year of antiretroviral therapy: comparison between low-income and high-income countries. Lancet 367: 817–824.
-
6.
van Oosterhout JJ, Bodasing N, Kumwenda JJ, Nyirenda C, Mallewa J, Cleary PR, de Baar MP, Schuurman R, Burger DM, Zijlstra EE, 2005. Evaluation of antiretroviral therapy results in a resource-poor setting in Blantyre, Malawi. Trop Med Int Health 10: 464–470.
-
7.
Gill CJ, Hamer DH, Simon JL, Thea DM, Sabin LL, 2005. No room for complacency about adherence to antiretroviral therapy in sub-Saharan Africa. AIDS 19: 1243–1249.
-
8.
Marazzi MC, Bartolo M, Emberti Gialloreti L, Germano P, Guidotti G, Liotta G, Magnano San Lio M, Mancinelli S, Modolo MA, Narciso P, Perno CF, Scarcella P, Tintisona G, Palombi L, 2006. Improving adherence to highly active anti-retroviral therapy in Africa: the DREAM programme in Mozambique. Health Educ Res 21: 34–42.
-
9.
Uzochukwu BS, Onwujekwe OE, Onoka AC, Okoli C, Uguru NP, Chukwuogo OI, 2009. Determinants of non-adherence to subsidized anti-retroviral treatment in southeast Nigeria. Health Policy Plan 24: 189–196.
-
10.
Orrell C, Bangsberg DR, Badri M, Wood R, 2003. Adherence is not a barrier to successful antiretroviral therapy in South Africa. AIDS 17: 1369–1375.
-
11.
2006. AIDS Patients Call for Holistic Approach. The Post. Lusaka.
-
12.
IRIN, 2008. Living with HIV on an empty stomach. UN Office for the Coordination of Humanitarian Affairs.
-
13.
Carlucci JG, Kamanga A, Sheneberger R, Shepherd BE, Jenkins CA, Spurrier J, Vermund SH, 2008. Predictors of adherence to antiretroviral therapy in rural Zambia. J Acquir Immune Defic Syndr 47: 615–622.
-
14.
Heckman TG, Somlai AM, Peters J, Walker J, Otto-Salaj L, Galdabini CA, Kelly JA, 1998. Barriers to care among persons living with HIV/AIDS in urban and rural areas. AIDS Care 10: 365–375.
-
15.
Mills EJ, Nachega JB, Buchan I, Orbinski J, Attaran A, Singh S, Rachlis B, Wu P, Cooper C, Thabane L, Wilson K, Guyatt GH, Bangsberg DR, 2006. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA 296: 679–690.
-
16.
Gorman AA, Foley JM, Ettenhofer ML, Hinkin CH, van Gorp WG, 2009. Functional consequences of HIV-associated neuropsychological impairment. Neuropsychol Rev 19: 186–203.
-
17.
Norman LR, Basso M, Kumar A, Malow R, 2009. Neuropsychological consequences of HIV and substance abuse: a literature review and implications for treatment and future research. Curr Drug Abuse Rev 2: 143–156.
-
18.
Peltzer K, Friend-du Preez N, Ramlagan S, Anderson J, 2010. Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa. BMC Public Health 10: 111.
-
19.
Birbeck G, Chomba E, Kvalsund M, Bradbury R, Mang'ombe C, Malama K, Kaile T, Byers P, Organek N, 2009. Antiretroviral adherence in rural Zambia: the first year of treatment availability. Am J Trop Med Hyg 80: 669–674.
-
20.
Birbeck G, Chomba E, Atadzhanov M, Mbewe E, Haworth A, 2007. The social and economic impact of epilepsy in Zambia: a cross-sectional study. Lancet Neurol 6: 39–44.
-
21.
Sacktor NC, Wong M, Nakasujja N, Skolasky RL, Selnes OA, Musisi S, Robertson K, McArthur JC, Ronald A, Katabira E, 2005. The International HIV Dementia Scale: a new rapid screening test for HIV dementia. AIDS 19: 1367–1374.
-
22.
Kvalsund M, Haworth A, Murman D, Velie E, Birbeck G, 2009. Closing Gaos in ART access: HIV-D screening instruments for non-physician healthcare workers. Am J Trop Med Hyg 80: 1054–1059.
-
23.
Jelsma J, Mhundwa K, De Weerdt W, De Cock P, Chimera J, Chivaura V, 2001. The reliability of the Shona version of the EQ-5D. Cent Afr J Med 47: 8–13.
-
24.
Patel V, Simunyu E, Gwanzura F, Lewis G, Mann A, 1997. The Shona Symptom Questionnaire: the development of an indigenous measure of common mental disorders in Harare. Acta Psychiatr Scand 95: 469–475.
-
25.
Kandiah PA, Atadzhanov M, Kvalsund MP, Birbeck GL, 2010. Evaluating the diagnostic capacity of a single-question neuropathy screen (SQNS) in HIV positive Zambian adults. J Neurol Neurosurg Psychiatry 81: 1380–1381.
-
26.
Central Statistical Office, 2008. Living Conditions. Available at: http://www.zamstats.gov.zm/lcm.php. Accessed August 6, 2011.
-
27.
Coetzee D, Hildebrand K, Boulle A, Maartens G, Louis F, Labatala V, Reuter H, Ntwana N, Goemaere E, 2004. Outcomes after two years of providing antiretroviral treatment in Khayelitsha, South Africa. AIDS 18: 887–895.
-
28.
Lawn SD, Harries AD, Anglaret X, Myer L, Wood R, 2008. Early mortality among adults accessing antiretroviral treatment programmes in sub-Saharan Africa. AIDS 22: 1897–1908.
-
29.
Zachariah R, Harries K, Moses M, Manzi M, Line A, Mwagomba B, Harries AD, 2009. Very early mortality in patients starting antiretroviral treatment at primary health centers in rural Malawi. Trop Med Int Health 14: 713–721.
-
30.
Maskew M, MacPhail P, Menezes C, Rubel D, 2007. Lost to follow up: contributing factors and challenges in South African patients on antiretroviral therapy. S Afr Med J 97: 853–857.
-
31.
Yu JK, Chen SC, Wang KY, Chang CS, Makombe SD, Schouten EJ, Harries AD, 2007. True outcomes for patients on antiretroviral therapy who are “lost to follow-up” in Malawi. Bull World Health Organ 85: 550–554.
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