Association of First-line Antiretroviral Therapy Adherence with Adherence to Second-line Antiretroviral Therapy Among HIV-infected Patients in Tanzania

Habib O. Ramadhani, John A. Bartlett, Nathan M. Thielman, Brian W. Pence, Stephen M. Kimani, Venance P. Maro, Mtumwa S. Mwako, Lazaro J. Masaki, Calvin E. Mmbando, Mary G. Minja, Eileen S. Lirhunde and William C. Miller
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Background. Adherence to first-line antiretroviral therapy (ART) may be an important indicator of adherence to second-line ART. Evaluating this relationship may be critical to identify patients at high risk for second-line failure, thereby exhausting their treatment options, and to intervene and improve patient outcomes. 

Methods. Adolescents and adults (n=436) receiving second-line ART were administered standardized questionnaires that captured demographic characteristics and assessed adherence. Optimal and suboptimal cumulative adherence were defined as percentage adherence of≥90% and<90% respectively. Bivariable and multivariable binomial regression models were used to assess the prevalence of suboptimal adherence percentage by pre-switch adherence status.

Results. 134/436 (30.7%) participants reported suboptimal adherence to second-line ART. Among 322 participants who had suboptimal adherence to first-line ART, 117 (36.3%) had suboptimal adherence to second-line ART compared to 17/114 (14.9%) who had optimal adherence to first-line. Participants who had suboptimal adherence to first-line ART were more likely to have suboptimal adherence to second-line ART (APR 2.4, 95% CI 1.5 – 3.9).

Conclusion. Adherence to first-line ART is an important predictor of adherence to second-line ART. Targeted interventions should be evaluated in patients with suboptimal adherence prior to switching into second-line therapy to improve their outcomes.