Table 2.
Recent reports on highly active antiretroviral therapy programs in sub-Saharan Africa.
| Country | Lead author | External support |
Cohort size |
Study design |
Surrogate markers |
Reported adherence rates | Duration of Observation |
Comments |
|---|---|---|---|---|---|---|---|---|
| Programmes without apparent external supports | ||||||||
| Cote d’Ivoire | Eholie [28] | NA | 308 | CS, PL | SR | 48% with > 90% ADH | 22 months per patient | Mean VL was 2.9 log10 copies/ml for patients with >90% ADH |
| Cameroon | Akam [25] | NA | 333 | PL | Not stated | Mean ADH was 68% | ≥ 12 months per patient | Declining adherence note over time |
| Botswana | Nwokike [38] | NA | 176 | CS | SR, PC | Mean ADH was 83% | Not stated | Author concluded that ADH was ‘sub-optimal’ |
| Programs with known external supports | ||||||||
| Burkina Faso | Traore [39] | Author or co-author | 80 | CS | SR | 30% ‘completely adherent’; 70% ‘non-adherent’ | NA | Counseling helped 75% of previously ‘non-adherent’ to improve adherence |
| Uganda | Byakika-Tusime [40] | Author or co-author | 304 | CS | SR | 67% with > 95% ADH; 71% with > 80% ADH | NA | 60% three-drug ART; 30% two-drug ART; 10% monotherapy |
| South Africa | Brown [29] | Author or co-author | 50 | CS | SR | 76% with 100% ADH; 8% with ≤ 50% ADH | NA | Mean UDVL was 55%; 57% UDVL for patients claiming 100% ADH |
| South Africa | Ferris [41] | Author or co-author | 74 | CS | SR | Mean ADH was 91%; 77% with ≥ 95% ADH | NA | 97% with UDVL if ≥ 95% adherence; 65% with UDVL if <95% adherence |
| Nigeria | Daniel [42] | Author or co-author | 53 | CS | SR | 79% with ≥ 95% ADH | NA | Final mean CD4 cell count was 262 × 106 cells/l |
| Senegal | Laurent [24] | Author or co-author | 58 | PL | SR | 98% with ≥ 80% ADH at month 1; 81% with ≥ 80% ADH by month 18 | 18 months | Progressive decline in adherence and proportion of patients with UDVL |
| Uganda | Shihab [30] | Author or co-author | 137 | CS | SR | 82% with 100% ADH | NA | 66% achieved UDVL |
| South Africa | Darder [17] | MSF | 539 | PL | SR | 88% with > 95% ADH at 1 month; 89% at 3 months; 88% at 12 months | 12 months | UDVL levels correlated with adherence levels |
| Uganda | Oyugi [26] | Author or co-author | 70 | PL | SR, VAS, PC, EDM | PC ADH, 86%; SR ADH, 85%; VAS ADH, 88%; EDM ADH, 82% | 24 weeks | Overall 78% with UDVL |
| Only 32/70 patients completed 24 weeks of observation | ||||||||
| Rwanda | Omes [27] | Author or co-author | 95 | CT | SR, TDM, VAS | SR, 95% with 100% ADH; VAS, 87% with 100% ADH; TDM, 85% in therapeutic range, 15% detectable | Not stated | >90% reported side effects |
| Uganda | Muganzi [16] | MSF | 530 | PL | SR, PC | 98% with > 95% ADH | Not stated | 1.3% defaulted from HAART program; 10.2% died |
| DRC | Tu [43] | MSF | 30 | PL | SR, PC | 100% with 100% ADH at 3 months | 3 months | Mean increase in CD4 cell count, 153 × 106 cells/l |
| Mozambique | Gialloreti [44] | Author or co-author | 82 | PL | Not stated | ADH was ‘very high’ | Not stated | 71% achieved UDVL |
ADH, Adherence; ART, antiretroviral therapy; CS, cross sectional; CT, clinical trial; DRC, Democratic Republic of Congo; EDM, electronic drug monitor; MSF, Médecins Sans Frontières; NA, not applicable; PC, pill count; PL, prospective longitudinal; SR, self report; TDM, Therapeutic Drug Monitoring; UDVL, undetectable viral load; VAS, visual analog scale; VL, viral load.