ART adherence and viral suppression are high among most non-pregnant individuals with early-stage, asymptomatic HIV infection: an observational study from Uganda and South Africa

Jessica E. Haberer, Bosco M. Bwana, Catherine Orrell, Stephen Asiimwe, Gideon Amanyire, Nicholas Musinguzi, Mark J. Siedner, Lynn T. Matthews, Alexander C. Tsai, Ingrid T. Katz, Kathleen Bell, Annet Kembabazi, Stephen Mugisha, Victoria Kibirige, Anna Cross, Nicola Kelly, Bethany Hedt-Gauthier, David Bangsberg

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

INTRODUCTION: The success of universal antiretroviral therapy (ART) access and aspirations for an AIDS-free generation depend on high adherence in individuals initiating ART during early-stage HIV infection; however, adherence may be difficult in the absence of illness and associated support. METHODS: From March 2015 to October 2017, we prospectively observed three groups initiating ART in routine care in Uganda and South Africa: men and non-pregnant women with early-stage HIV infection (CD4 > 350 cells/μL), pregnant women with early-stage HIV infection and men and non-pregnant women with late-stage HIV infection (CD4 < 200 cells/μL). Socio-behavioural questionnaires were administered and viral loads were performed at 0, 6 and 12 months. Adherence was monitored electronically. RESULTS: Adherence data were available for 869 participants: 322 (37%) early/non-pregnant, 199 (23%) early/pregnant and 348 (40%) late/non-pregnant participants. In Uganda, median adherence was 89% (interquartile range 74 to 96) and viral suppression was 90% at 12 months; neither differed among groups (p > 0.72). In South Africa, median adherence was higher in early/non-pregnant versus early/pregnant or late/non-pregnant participants (76%, 37%, 52%; p < 0.001), with similar trends in viral suppression (86%, 51%, 79%; p < 0.001). Among early/non-pregnant individuals in Uganda, adherence was higher with increasing age and lower with structural barriers; whereas in South Africa, adherence was higher with regular income, higher perceived stigma and use of other medications, but lower with maladaptive coping and cigarette smoking. DISCUSSION: ART adherence among non-pregnant individuals with early-stage infection is as high or higher than with late-stage initiation, supporting universal access to ART. Challenges remain for some pregnant women and individuals with late-stage infection in South Africa and highlight the need for differentiated care delivery.

Original languageEnglish (US)
Pages (from-to)e25232
JournalJournal of the International AIDS Society
Volume22
Issue number2
DOIs
StatePublished - Feb 1 2019

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Asymptomatic Infections
Uganda
South Africa
HIV Infections
Observational Studies
Pregnant Women
Therapeutics
Infection
Acquired Immunodeficiency Syndrome
Smoking

Keywords

  • adherence
  • antiretroviral therapy
  • HIV
  • stage of disease
  • sub-Saharan Africa

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Infectious Diseases

Cite this

ART adherence and viral suppression are high among most non-pregnant individuals with early-stage, asymptomatic HIV infection : an observational study from Uganda and South Africa. / Haberer, Jessica E.; Bwana, Bosco M.; Orrell, Catherine; Asiimwe, Stephen; Amanyire, Gideon; Musinguzi, Nicholas; Siedner, Mark J.; Matthews, Lynn T.; Tsai, Alexander C.; Katz, Ingrid T.; Bell, Kathleen; Kembabazi, Annet; Mugisha, Stephen; Kibirige, Victoria; Cross, Anna; Kelly, Nicola; Hedt-Gauthier, Bethany; Bangsberg, David.

In: Journal of the International AIDS Society, Vol. 22, No. 2, 01.02.2019, p. e25232.

Research output: Contribution to journalArticle

Haberer, JE, Bwana, BM, Orrell, C, Asiimwe, S, Amanyire, G, Musinguzi, N, Siedner, MJ, Matthews, LT, Tsai, AC, Katz, IT, Bell, K, Kembabazi, A, Mugisha, S, Kibirige, V, Cross, A, Kelly, N, Hedt-Gauthier, B & Bangsberg, D 2019, 'ART adherence and viral suppression are high among most non-pregnant individuals with early-stage, asymptomatic HIV infection: an observational study from Uganda and South Africa', Journal of the International AIDS Society, vol. 22, no. 2, pp. e25232. https://doi.org/10.1002/jia2.25232
Haberer, Jessica E. ; Bwana, Bosco M. ; Orrell, Catherine ; Asiimwe, Stephen ; Amanyire, Gideon ; Musinguzi, Nicholas ; Siedner, Mark J. ; Matthews, Lynn T. ; Tsai, Alexander C. ; Katz, Ingrid T. ; Bell, Kathleen ; Kembabazi, Annet ; Mugisha, Stephen ; Kibirige, Victoria ; Cross, Anna ; Kelly, Nicola ; Hedt-Gauthier, Bethany ; Bangsberg, David. / ART adherence and viral suppression are high among most non-pregnant individuals with early-stage, asymptomatic HIV infection : an observational study from Uganda and South Africa. In: Journal of the International AIDS Society. 2019 ; Vol. 22, No. 2. pp. e25232.
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AU - Haberer, Jessica E.

AU - Bwana, Bosco M.

AU - Orrell, Catherine

AU - Asiimwe, Stephen

AU - Amanyire, Gideon

AU - Musinguzi, Nicholas

AU - Siedner, Mark J.

AU - Matthews, Lynn T.

AU - Tsai, Alexander C.

AU - Katz, Ingrid T.

AU - Bell, Kathleen

AU - Kembabazi, Annet

AU - Mugisha, Stephen

AU - Kibirige, Victoria

AU - Cross, Anna

AU - Kelly, Nicola

AU - Hedt-Gauthier, Bethany

AU - Bangsberg, David

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N2 - INTRODUCTION: The success of universal antiretroviral therapy (ART) access and aspirations for an AIDS-free generation depend on high adherence in individuals initiating ART during early-stage HIV infection; however, adherence may be difficult in the absence of illness and associated support. METHODS: From March 2015 to October 2017, we prospectively observed three groups initiating ART in routine care in Uganda and South Africa: men and non-pregnant women with early-stage HIV infection (CD4 > 350 cells/μL), pregnant women with early-stage HIV infection and men and non-pregnant women with late-stage HIV infection (CD4 < 200 cells/μL). Socio-behavioural questionnaires were administered and viral loads were performed at 0, 6 and 12 months. Adherence was monitored electronically. RESULTS: Adherence data were available for 869 participants: 322 (37%) early/non-pregnant, 199 (23%) early/pregnant and 348 (40%) late/non-pregnant participants. In Uganda, median adherence was 89% (interquartile range 74 to 96) and viral suppression was 90% at 12 months; neither differed among groups (p > 0.72). In South Africa, median adherence was higher in early/non-pregnant versus early/pregnant or late/non-pregnant participants (76%, 37%, 52%; p < 0.001), with similar trends in viral suppression (86%, 51%, 79%; p < 0.001). Among early/non-pregnant individuals in Uganda, adherence was higher with increasing age and lower with structural barriers; whereas in South Africa, adherence was higher with regular income, higher perceived stigma and use of other medications, but lower with maladaptive coping and cigarette smoking. DISCUSSION: ART adherence among non-pregnant individuals with early-stage infection is as high or higher than with late-stage initiation, supporting universal access to ART. Challenges remain for some pregnant women and individuals with late-stage infection in South Africa and highlight the need for differentiated care delivery.

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