HIV Patient Treatment Adherence Trajectories in First 24 months After ART Initiation Among Adults: An Electronic Health Records Cohort From South Africa.

BACKGROUND

HIV treatment-as-prevention has taken a distinctly biomedical turn focusing on long-acting therapies, yet high adherence to antiretroviral therapy (ART) cannot be dispensed with. We investigated the dynamics of early treatment adherence patterns and associated demographic-clinical factors in South Africa using data from a large adult cohort (N = 995,889) initiating ART between 2015 and 2018 in the national HIV electronic medical record system in South Africa.

METHODS

Using ( TIER.net ), an HIV database across 4 provinces (KwaZulu-Natal, Mpumalanga, Limpopo, and Northern Cape), we calculated monthly proportion of days covered by ART per individual over the first 24 months after ART initiation, calculated adherence prevalence and then defined adherence transitions within and across adherence levels over time. Last, we identified groups with shared adherence trajectories against the optimum level, i.e., achieving, sustaining, and relapsing and predictive factors using modified Poisson logistic models.

RESULTS

Mean treatment adherence was 54% during the first 12 months and 47% in months 13-24. Most (85%) patients least adherent (0%-25%) during the first 12 months after ART initiation failed to transition to high level adherence in the subsequent 12-month period. Although patients initiating ART in 2018 compared with earlier were more likely to sustain optimal adherence levels, men compared with women were less likely to achieve optimal adherence while patients ≥25 years had higher adherence rebound potential compared with those 15-24 years.

CONCLUSIONS

The nuance of different patterns of adherence can be predicted and, therefore, preventable to advance the Undetectable = Untransmittable strategy to halt new transmissions by 2030.