ART Adherence Among People in
Rural Zambian Clinics
Principal Investigator:
- Gretchen L. Birbeck, M.D., M.P.H.,
Michigan State University
Co-Investigators:
- Elwyn M. Chomba, M.MED., University Teaching Hospital Zambia
- Alexis M. Sinyama, M.B.Ch.B., Zambia Sugar Plc.
Abstract
More than 20 years into the AIDS epidemic in sub-Saharan Africa (SSA), antiretroviral therapy (ART) is finally becoming available to the general public. The initial roll out of ART occurred primarily at urban healthcare facilities, usually large teaching hospitals. However, a third to a half of the people living with AIDS in SSA reside in rural regions too distant from the cities to access AIDS-related care there. Now, ART is slowly becoming available through clinics located in rural regions of Zambia. The social, economic, medical, and cultural environment of rural regions of Africa differs greatly from the urban centers.
Unfortunately, little is known regarding the determinants of drug adherence in rural regions. To begin to explore patient and organizational-level determinants of ART adherence among patients attending rural clinics in Zambia, we propose to conduct a study at 3 rural ART clinics in the Southern Province of Zambia. By assembling a cohort of new attendees at these rural ART clinics, we will prospectively assess the impact of socioeconomic status, ART-toxicity, social roles/responsibilities, perceived levels of HIV-associated stigma, pre-treatment cognitive deficits, health systems limitations, and co-morbid depression upon ART adherence. Adherence will be quantified based upon pill counts and clinic attendance. Individuals who agree to community-based visits and fail to attend scheduled ART clinic visits will be sought at home to determine reasons for non-adherence. In addition to assessing potential factors associated with poorer adherence, the study team will work with non-adherent patients and ART clinic staff to overcome barriers to treatment adherence for individual patients as these patients are identified. Structured interviews of clinic staff and administration will also be conducted to assist us in understanding underlying causes for health systems limitations that negatively impact adherence.