AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #338 - Predictors of the failure to maintain adherence to antiretroviral therapy in HIV-infected migrants living in France and travelling to their sub-Saharan African country of origin
Authors: Presenting Author: Dr Bruno Spire - INSERM
Additional Authors: Mr. Lionel Fugon, Dr. Nathalie Lele, Mme Estelle Carde, Dr. Michelle Bentata, Dr. Olivier Patey, Dr. Marie-Aude Khuong, Dr. Bruno Spire, Mme Patrizia Carrieri, Prof. Olivier Bouchaud,
Aim: HIV-infected African immigrants living in France may have occasion to travel to their native country. Maintaining their adherence behaviors to antiretroviral therapy (ART) while abroad may prove challenging. The aim of this study was to evaluate to what extent factors related to such a journey may cause adherence failure in otherwise adherent ART-treated migrants with previously stable virological response.
Method / Issue: A total of 268 HIV-infected patients were included in the survey. All had plasma viral loads < 200 copies/ml, had not changed their combination antiretroviral therapy for at least three months and were about to go on a trip to their sub-Saharan country of origin for between two weeks and six months. Patients completed a self-administered adherence questionnaire on each of three clinical visits: at enrolment (i.e. during the 4 weeks preceding the trip (V0)), during the week following their return to France (V1) and between the 8th and 12th weeks following their return (V2). Using a logistic regression model, rate and risk factors of adherence failure during the journey were analyzed for the 200 patients adherent to ART at V0 and who completed the adherence questionnaire at V1.
Results / Comments: Adherence failure occurred in 23 (11.5%) of the 200 patients during their stay in their native country. Negative perception about ART effectiveness, unexpected traumatic events during the stay and a prolongation of the stay were all associated with a higher likelihood of adherence failure (aOR, 4.30; 95%CI, 1.30-13.68; aOR, 7.78; 95%CI, 2.32-26.12; aOR, 5.27; 95%CI, 1.36-20.36; respectively), while owning/renting one’s house in France, singlehood and HIV status disclosure were associated with a lower likelihood of adherence failure (aOR, 0.30; 95%CI, 0.10-0.96; aOR, 0.23; 95%CI, 0.05-1.00; aOR, 0.19; 95%CI, 0.05-0.76; respectively).
Discussion: Traveling to one’s native country may lead to adherence failure in sub-Saharan HIV-infected migrants. Accordingly, these patients should receive reinforced and tailored counseling for adherence and HIV status disclosure. Ensuring they receive enough medications in case of prolonged stay is important to minimize any risk of adherence failure.
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