The review was directed by researchers from the Centre for International Health and Human Rights Studies and the University of California, San Francisco.
"This review contradicts a historical anticipation of poor adherence by Africans to antiretroviral regimens that was offered as a rationale to delay providing these therapies. If one had considered adherence simply on the basis of evidence, Sub-Saharan Africans would have had access to these life-saving therapies earlier," said study lead author Edward Mills, PhD, MSc, director of the Centre for International Health and Human Rights Studies.
The review, published in the August 9 issue of the Journal of the American Medical Association, looked at data from 31 studies from North America involving 17,573 HIV-infected patients and 27 studies from Sub-Saharan African involving 12,116 HIV-infected patients. Findings showed that 59 percent of North Americans took their medications as directed, while 77 percent of Sub-Saharan Africans adhered to their antiretroviral regimens.
"Thinking that poverty was a risk factor for non-adherence was a mistake. Not all poverty is the same; poverty in resource-limited settings presents a different set of challenges than poverty in the U.S. Missed doses among the poor in resource-limited settings is less about neglected doses due to complex behavioral and social problems and is more about structural barriers to reliable medication access," said study senior author David R. Bangsberg, MD, MPH, UCSF associate professor of medicine and director of the UCSF Epidemiology and Prevention Interventions Center at San Francisco General Hospital Medical Center.
While these high levels of adherence in resource-limited settings are reassuring, the authors call for programs to monitor and sustain this level of adherence.
"Adherence in Africa will decline as benefits of treatment plateau and long-term side effects accumulate and when people
Contact: Jeff Sheehy
University of California - San Francisco