Measuring Adherence to Antiretroviral Treatment

The Role of Pharmacy Records of Drug Withdrawals

Eliana Battaggia Gutierrez; Ana Marli Christovam Sartori; Ana Lucia Schmidt; Bruna Mamprim Piloto; Bruna Biagi França; Adriana Santos de Oliveira; Adriana Rodrigues Pouza; Roberta Vilela Moreno; Camila de Melo Picone; Manoel Carlos Sampaio de Almeida Ribeiro


AIDS and Behavior. 2012;16(6):1482-1490. 

In This Article

Abstract and Introduction


This study aimed to evaluate adherence to antiretroviral treatment (ART) among HIV + adults, assess its association with HIV viral load (VL) and identify factors associated to adherence. A survey involving a random sample of adults followed at a HIV/AIDS reference center in São Paulo city, Brazil, from 2007 to 2009 was done. A questionnaire was applied and data were retrieved from the pharmacy and medical records. The study involved 292 subjects: 70.2% men; median age: 43 years; median duration of ART: 8 years. 89.3% self-reported taken all prescribed pills in the last 3 days but only 39.3% picked up ≥95% of the prescribed ART from the pharmacy in the last 12 months. At the multivariate analysis having symptoms prior to ART, taking fewer ART pills, and not missing medical appointments were independently associated to higher adherence. Adherence was strongly associated with undetectable HIV VL. Rates of undetectable HIV VL did not differ from 80 to ≥95% of adherence.


Advances in antiretroviral treatment (ART) over the last 15 years have led to dramatic changes in the prognosis, quality of life and management of people living with human immunodeficiency virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS). In Brazil, universal access to free of charge combined ART (cART), as well as free clinical and laboratorial monitoring, is provided through the Unified Health System (Sistema Único de Saúde, SUS). This policy resulted in a reduction in the number of HIV-related hospitalizations in the public health system and in the demand for treatment of opportunistic infections, increased survival, and improved quality of life of persons living with HIV/AIDS.[1]

Effectiveness of cART depends on many factors such as access to health services and treatment, characteristics of the virus and the immune response, and factors related to the individual behavior, among which adherence to treatment is a key factor and a major challenge. Suboptimal adherence to cART reduces effective viral suppression, allows viral resistance, and increases the risk of opportunistic diseases.[2] Besides, adherence to cART has an epidemiological importance, as shown by recent papers that demonstrated the role of treatment in the prevention of HIV transmission.[3,4]

Persons living with HIV/AIDS are expected to adhere to complex treatment schedules over an indefinite period of time. Adherence to chronic treatment involves a multifactorial, complex and dynamic behavior, and may oscillate overtime. Periodic assessments and reinforcements are necessary.[5] Understanding barriers to adherence is critical to improve patients' agreement to treatment, maximize virologic suppression and reduce HIV morbidity and mortality.

The aims of this study were to evaluate adherence to cART among adults living with HIV/AIDS followed at a public health service specialized in HIV/AIDS care, in São Paulo, a large city in the Southeast of Brazil; to assess the association of adherence with undetectable HIV viral load; and to identify factors associated to adherence.


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