Africans take anti-HIV meds at a higher rate than many anticipated

By Jeff Sheehy

Contrary to widespread assumptions, UCSF researchers have found that an HIV-infected African cohort successfully followed a medication regimen, taking almost all of the anti-HIV drugs as prescribed and at a rate as high or higher than observed in published studies of HIV-infected cohorts in rich countries.

“Our Ugandan cohort took on average between 91 and 94 percent of the medications as prescribed.  We verified this rate using multiple state of the art adherence measures and observed high rates of viral suppression consistent with the high level of adherence,” said the study’s lead investigator, Jessica Oyugi, MD, UCSF assistant professor of medicine at the UCSF Epidemiology and Prevention Interventions (EPI) Center at San Francisco General Hospital Medical Center.

The study, published in the August 15, 2004 issue of Journal of Acquired Immune Deficiency Syndromes, followed 34 participants and observed their adherence to a generic fixed dose combination antiretroviral regimen for 12 weeks using multiple adherence measures.  The measures included 3-day self-report, 30-day visual analog (patients draw a line between 0 and 100 percent that expresses the percentage of pills taken) electronic medication monitoring (the pill bottle records each time it is opened), and unannounced pill counts taken at each participant’s residence.

Seventy-six percent of the participants were able to reduce the levels of virus in their blood below the level of detection using standard viral load tests that measure virus levels higher than 400 copies/ml. Half of the participants had incomes lower than $50 a month, and small business owners, police officers, tailors, teachers, and housemaids were the most common occupations.

“If these results hold up as treatment expands, I think they indicate that the expectation that poverty itself is a barrier to adherence is incorrect” said study co-investigator David R. Bangsberg, MD, MPH, UCSF associate professor of medicine and director of the EPI Center at SFGHMC.

Co-authors for the study are Jayne Byakika-Tusiime, BPharm, MSc, epidemiologist, and Roy Mugerwa, MMed, professor of medicine, from the Makerere University Faculty of Medicine, and also from the Academic Alliance for AIDS Care and Prevention in Africa, Kampala, Uganda; Cissy Kityo, MMed, MPH, research director, from the Joint Clinical Research Center, Kampala; Edwin D. Charlebois, PhD, MPH, UCSF assistant professor of medicine at the AIDS Policy Research Center of the UCSF AIDS Research Institute; and Peter Mugyeni, MMed, director of the Joint Clinical Research Center, also with the Academic Alliance for AIDS Care and Prevention in Africa, Kampala.

The study was funded by grants from the National Institute of Mental Health, the UCSF/Gladstone Institute for Virology and Immunology Center for AIDS Research, the Fogarty International Training Program, and The Doris Duke Charitable Foundation.

The Epidemiology and Prevention Interventions Center is a component of the UCSF AIDS Research Institute (ARI). UCSF ARI houses hundreds of scientists and dozens of programs throughout UCSF and affiliated labs and institutions, making ARI one of the largest AIDS research entities in the world.