Virological treatment failure in HIV-infected adults in Uganda: Risk factors: poor adherence, resistance patterns & intervention strategies.
From May 1st 2014 to June 30th 2015 we had conducted an observational trial at the Infectious Diseases Institute (IDI) of Makerere University in Kampala, Uganda. Our study focused on the core challenges of ART (Antiretroviral Therapy) in HIV-infected adults in this resource-limited setting.
Multiple observational studies aimed to identify factors fostering poor adherence to ART in resource-limited settings and assessed the impact of specific intervention strategies. Common reasons for missed ART doses worldwide are side-effects and pill-burden, which become less apparent with the introduction of combined tablets and improved tolerability of new substances. In resource-limited settings structural factors such as stock-outs of drugs are widely known, as are economic and financial aspects such as unemployment. A number of African studies were able to demonstrate a strong influence of food insecurity on adherence as well as alcohol consumption in some regions. These observations were translated into feasible interventions such as distribution of food parcels and addressing alcohol specifically during counseling. Other studies found education and in particular knowledge on HIV and ART to influence adherence substantially.
We plan to perform viral load measurements in order to identify patients with virological failure as opposed to patients identified by conventional immunological monitoring strategies. Furthermore, resistance testing was done in patients with virological failure in order to assess emerging resistance mutations, as well as the impact of this not widely available test on choice of future treatment.
Through structured patient interviews we aim to identify risk factors for poor adherence to ART in our study population and translate these into points of intervention that ultimately improve treatment outcome.
Dr. med. Amrei von Braun, University Hospital Zürich, Division of Infectious Diseases and Hospital Epidemiology, Zürich
Dr. med. Andrew Kambungu, Head of Research, Institute for Infectious Diseases IDI, Makerere University of Kampala, Uganda