Retention in care, viral suppression, treatment adherence and quality of life in a public antiretroviral therapy program in Addis Ababa, Ethiopia

In his thesis, Legese A. Mekuria presents the results of a PhD study which was undertaken in 10 health-care facilities in Addis Ababa, Ethiopia. The overall aim was to estimate retention in HIV care, viral suppression, medication adherence and patients’ health-related quality of life (HRQoL). An additional aim was to investigate the predictors of attrition, detectable viremia, sub-optimal adherence and poor HRQoL. A total of 870 patients who initiated cART between May 2009 and April 2012 were randomly selected from the ART-register. Six hundred sixty four (76.3%) patients who were alive, were retained in HIV care and using cART for at least six months underwent a face-to-face interview to assess medication adherence and HRQoL. Adherence was measured by self-report, clinician-recorded and pharmacy-refill measures, and HRQoL by the WHOQoL-HIV BREF questionnaire. Plasma HIV-1 RNA concentration was measured by using the Abbott m2000RealTime HIV-1 assay in the 642 patients who provided a blood sample. The study findings resulted in seven main lessons learned. First, retention in HIV care was comparable with, or even better than that achieved in resource-limited or EU/USA settings. Second, early attrition from care shortly after cART initiation was evident. Third, on-treatment viral suppression levels were high. Fourth, treatment adherence was also high, but there is room for improvement as sub-optimal adherence was present. Fifth, younger age is potentially predictive of non-adherence to cART and detectable viremia. Sixth, late presentation with low CD4 cell count at enrollment in HIV care or at cART initiation appears an important underlined cause for poor cART outcomes. Finally, high levels of depressive symptoms and HIV stigma were most strongly and most consistently associated with poor HRQoL. Addressing these lessons learned might help future clinical and public health research and other public ART programs to strive for a lasting impact