Self-Reported on Antiretroviral Therapy (ART) Without Detectable Antiretrovirals (ARVs): Implications for Adherence in Zimbabwe based on the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA), 2015-2016 and 2020 Open Access
Schwartz, Sydney (Spring 2024)
Abstract
Background: Antiretroviral therapy (ART) is the primary treatment for HIV infection. Taking ART can lead an individual to become undetectable, meaning the amount of HIV or viral load (VL) in the individual's blood is unmeasurable. Optimal adherence may be difficult to monitor in low- or middle-income countries (LMIC), as many rely on patient self-reporting of ART. In Zimbabwe, where self-reporting is the most feasible option to measure ART adherence, assessing the level of concordance between self-report and detectable antiretrovirals (ARVs) in the blood is essential. We set out to determine the concordance of self-reported ART and detectable levels of ARVs in the Zimbabwean population and the change in concordance from 2015-2016 to 2020.
Methods: This study used the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA) from 2015-2016 and 2020. We analyzed concordance for 3,563 HIV-positive individuals from 2015-2016 and 2,958 HIV-positive individuals from 2020. Participants' self-reported treatment status was classified as on ART or not on ART, and ARV status was not detectable or detectable. A chi-square test for difference in proportions was performed on the detectable ARV in the population and detectable ARV for those on ART in the population for the 2015-2016 and 2020 data. A Mantel-Haenszel chi-square test was performed on demographic and concordance data for the 2020 survey.
Results: The proportion of the population with detectable ARVs in 2015-2016 was 0.84 and rose to 0.94 in 2020. The proportion of detectable ARVs in the population for those reporting to be on ART was 0.94 in 2015-2016 and rose to 0.97 in 2020. Of the 3,563 HIV-positive participants from 2015-2016, 2,484 (69.72%) were concordant when comparing self-reported ART use and detectable ARV, while 164 (4.60%) were not concordant. Of the 2,958 HIV-positive participants from 2020, 2,418 (81.74%) were concordant, and 88 (2.97%) were not concordant.
Conclusions: From 2015-2016 to 2020, we observed a 10% increase in the proportion of the population with detectable ART and a 3% increase in the proportion of the population who reported being on ART with detectable ART. This observed increase suggests improvements in treatment uptake and adherence among HIV-positive individuals in Zimbabwe.
Table of Contents
Table of Contents
Introduction ………………………………………………………………………………………………………….. 1
Methods ……………………………………………………………………………………………………………….. 5
Sampling ……………………………………………………………………………………………………. 5
Eligibility …………………………………………………………………………………………………… 6
Data Collection ……………………………………………………………………………………………. 7
Data Analysis .…………………………………………………………………………………………….. 9
Results ……………………………………………………………………………………………………………….. 11
Discussion …………………………………………………………………………………………………………... 16
Strengths ………………………………………………………………………………………………….. 22
Limitations ………………………………………………………………………………………………… 22
Recommendations ………………………………………………………………………………………... 23
Citations……………………………………………………………………………………………………………... 25
Appendix: Figures and Tables ………………………………………………………………………………….. 29
About this Master's Thesis
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Self-Reported on Antiretroviral Therapy (ART) Without Detectable Antiretrovirals (ARVs): Implications for Adherence in Zimbabwe based on the Zimbabwe Population-based HIV Impact Assessment (ZIMPHIA), 2015-2016 and 2020 () | 2024-04-24 10:44:43 -0400 |
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