Adherence to antiretroviral therapy (ART), self-stigma and depression among people living with HIV (PLWH) in rural Zambia

Introduction: Sustaining high levels of adherence to antiretroviral therapy (ART) is a challenge in Zambia. This study aimed to identify the factors associated with ART adherence and to examine the relationship among ART adherence, self-stigma and depressive symptoms at the early months of treatment in rural Zambia.// Method: This is a field based observational longitudinal study in Mumbwa. Treatment naïve clients aged over 15 years, who initiated ART during September-November 2010, were enrolled. Clients were interviewed at the initiation of ART and at six weeks later. Clients'self-report was used for measuring ART adherence.// Result: Of 157 clients, 59.9% were fully adherent. In multivariable analysis, full adherence was associated with being female [Adjusted odds ratio (AOR), 6.4; 95% Confidence interval (CI), 1.7-23.5], experience of food insufficiency in the previous 30 days (AOR, 5.7; 95% CI, 1.6-21.2), spouse undergoing ART (AOR, 5.4; 95% CI, 1.4-19.9), self-stigma at the initiation of ART (AOR, 0.1; 95% CI, 0.02-0.6), being more depressed (AOR, 1.1; 95% CI, 1.0-1.3) and having less self-stigma (AOR, 0.6; 95% CI, 0.5-0.9) after six weeks compared with at the initiation of ART.// Conclusion: ART adherence continues to be a significant behavioral challenge in rural Zambia. Sex, food issues, spouse's ART use and mental health issues were associated with ART adherence. These are likely the issues that ART services will need to focus on in the future beyond current efforts such as increasing accessibility by expanding mobile ART services in rural Zambia.報告番号: 甲28311 ; 学位授与年月日: 2012-03-22 ; 学位の種別: 課程博士 ; 学位の種類: 博士(保健学) ; 学位記番号: 博医第3970号 ; 研究科・専攻: 医学系研究科国際保健学専