Original Research

Impact of combination antiretroviral therapy initiation on adherence to antituberculosis treatment

Marlene Knight, Robyn L. van Zyl, Ian Sanne, Jean Bassett, Annelies van Rie
Southern African Journal of HIV Medicine | Vol 16, No 1 | a346 | DOI: https://doi.org/10.4102/sajhivmed.v16i1.346 | © 2015 Marlene Knight, Robyn L. van Zyl, Ian Sanne, Jean Bassett, Annelies van Rie | This work is licensed under CC Attribution 4.0
Submitted: 09 January 2015 | Published: 08 October 2015

About the author(s)

Marlene Knight, Clinical HIV Research Unit, University of the Witwatersrand, South Africa; Department of Pharmacy and Pharmacology, University of the Witwatersrand, South Africa
Robyn L. van Zyl, Department of Pharmacy and Pharmacology, University of the Witwatersrand, South Africa
Ian Sanne, Right to Care, Johannesburg, South Africa
Jean Bassett, Witkoppen Health and Welfare Centre, Johannesburg, South Africa
Annelies van Rie, Department of Epidemiology, University of North Carolina, United States


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Abstract

Background: Healthcare workers are often reluctant to start combination antiretroviral therapy (ART) in patients receiving tuberculosis (TB) treatment because of the fear of high pill burden, immune reconstitution inflammatory syndrome, and side-effects.

Object: To quantify changes in adherence to tuberculosis treatment following ART initiation.

Design: A prospective observational cohort study of ART-naïve individuals with baseline CD4 count between 50 cells/mm3 and 350 cells/mm3 at start of TB treatment at a primary care clinic in Johannesburg, South Africa. Adherence to TB treatment was measured by pill count,self-report, and electronic Medication Event Monitoring System (eMEMS) before and after initiation of ART.

Results: ART tended to negatively affect adherence to TB treatment, with an 8% – 10% decrease in the proportion of patients adherent according to pill count and an 18% – 22% decrease in the proportion of patients adherent according to eMEMS in the first month following ART initiation, independent of the cut-off used to define adherence (90%, 95% or 100%). Reasons for non-adherence were multi factorial, and employment was the only predictor for optimal adherence (adjusted odds ratio 4.11, 95% confidence interval 1.06–16.0).

Conclusion: Adherence support in the period immediately following ART initiation could optimise treatment outcomes for people living with TB and HIV.


Keywords

MEMS; pill count; HIV, sub-Saharan Africa, tuberculosis

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