Discontinuation and Modification of Highly Active Antiretroviral Therapy in HIV-Infected Ugandans: Prevalence and Associated Factors

Kiguba, Ronald BPharm, MSc*; Byakika-Tusiime, Jayne BPharm, MSc*; Karamagi, Charles MB, ChB, MMED, PhD*; Ssali, Francis MB, ChB, MMED, MSc†; Mugyenyi, Peter MB, ChB, FRCPI, FRCPEdin†; Katabira, Elly MB, ChB, FRCP*

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e31805d8ae3
Epidemiology and Social Science
Abstract

Background: Data on discontinuation and modification of highly active antiretroviral therapy (HAART) are scarce among sub-Saharan African populations. We sought to estimate the prevalence and to identify factors associated with these phenomena in our resource-limited setting.

Methods: Patients were recruited into this cross-sectional study from 2 treatment centers in Kampala, Uganda. Discontinuation and modification were assessed by self-report using semistructured quantitative and unstructured qualitative interviews. Discontinuation was defined as the simultaneous stopping of all antiretrovirals for at least 1 month, and modification as the changing of at least 1 antiretroviral used in an initial HAART regimen. Factors independently associated with each outcome were assessed using multivariate logistic regression.

Results: Of 686 subjects evaluated, 94 (13.7%) had ever discontinued therapy, whereas 175 (25.5%) had ever modified their regimen. The median CD4 count was 175 (interquartile range: 66-297) cells/μL. Factors associated with discontinuation were HAART experience before starting the current regimen (odds ratio [OR] = 3.70, 95% confidence interval [CI]: 2.13 to 6.25), use of alternative medicines (OR = 2.18, 95% CI: 1.06 to 4.47), hospitalization (OR = 2.36, 95% CI: 1.32 to 4.20), and 1 year or less on HAART (OR = 11.11, 95% CI: 5.00 to 25.00). Modification was associated with more than 3 months' duration on HAART (OR = 3.13, 95% CI: 1.16 to 8.33) and being unmarried (OR = 1.64, 95% CI: 1.02 to 2.70).

Conclusions: The proportions of discontinuation and modification of antiretroviral therapy (ART) observed in our resource-poor setting pose a challenge to the limited treatment options presently available. Drug cost as a major reason for discontinuation of HAART has major implications for ART programs that charge fees in resource-limited settings.

Author Information

From the *Makerere University Medical School, Kampala, Uganda; and †Joint Clinical Research Centre, Kampala, Uganda.

Received for publication November 23, 2006; accepted March 16, 2007.

Funded by The Belgian Technical Corporation-Uganda.

Presented at the Seventh Annual Uganda Society for Health Scientists Conference, Kampala, Uganda, June 22-23, 2006; the Second Annual Faculty of Medicine/Institute of Public Health Conference, Kampala, Uganda, September 7-9, 2006; and at the Fourteenth Conference on Retroviruses and Opportunistic Infections (CROI), Los Angeles, CA, February 25-28, 2007.

Reprints: Ronald Kiguba, BPharm, MSc, PO Box 21124, Kampala, Uganda (e-mail: rkiguba@med.mak.ac.ug or kiguba@yahoo.co.uk).

© 2007 Lippincott Williams & Wilkins, Inc.