Antiretroviral Therapy Adherence in Far West Nepal: The need for Community-Based Intervention

Abstract

Background: Achham, a rural district in the Far West region of Nepal, has a high rate of human immunodeficiency virus (HIV) infection. Little information is available about HIV patients in this area. Non-adherence is a major cause of treatment failure worldwide, particularly in resource limited settings. This study investigated current adherence rates in a nongovernmental organization (NGO) based community hospital in Achham, and investigated socioeconomic and sociocultural factors that impacted overall adherence. Methods: A cross-sectional study of 105 patients receiving antiretroviral therapy (ART) was performed in Achham. Data were collected on health, socioeconomic, and socio-cultural status, as well as patient perceptions of adherence challenges using a Visual Analog Scale (VAS). Results: The overall rate of ART adherence was 85.7%. Socio-cultural factors pertaining to work and family obligations, as well as long distances to clinics, were significantly correlated with poor adherence. Conclusions: The development of community-based models for HIV care in Achham, similar to those used in Rwanda and Haiti, in combination with the deployment of community health volunteers for purposes of Directly Observed Therapy (DOT), may help to overcome the main barriers to adherence identified by this study. Keywords: Achham; adherence; ART; community-based interventions.