Adherence to antiretroviral therapy in Africa: how high is it really?

摘要

More than two million people in Africa are now receiving antiretroviral therapy (ART) compared with just 100,000 in 2003 (WHO 2008), and very high adherence to ART has been reported in a number of different settings. In a meta-analysis, on average, 82% of African patients reported taking 95% or more of their prescribed doses in the last 28 days, whereas only 55% of US patients did (Mills et al. 2006). In the UK, about 70% of patients are thought to be achieving this level of adherence (Brook et al. 2001). At face-value, these findings are very encouraging for the ART roll-out in Africa, but it would be surprising if adherence in Africa was in fact higher than in developed countries. In Africa, access to health care is restricted, monitoring and support of patients is less frequent, fewer antiretrovirals are available and the nature of side-effects and their management are less well understood.