Factors Influencing Adherence to Anti-retroviral Therapy in Amazonian Indigenous People Living with HIV/AIDS

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2023 Mar 16

PMID 36922774

Authors

Felix Valenzuela-Ore

Yolanda Angulo-Bazan

Lucy D Lazoriga-Sandoval

Norma L Cruz-Vilcarromero

Cecilia R Cubas-Sagardia

Affiliations

Soon will be listed here.

Abstract

Background: Indigenous communities in Peru has been historically affected by high mortality rates attributable to HIV-AIDS infection, associated with a low access to health services, and socio-cultural barriers. In this context, the study aimed to describe factors associated with antiretroviral treatment adherence in people from Awajun and Wampis indigenous communities, living with HIV-AIDS in a Peruvian Amazonian region.

Methods: A cross-sectional study was completed with a consecutive sample of people from indigenous communities (Awajun or Wampis) living with HIV, who were receiving antiretroviral treatment for at least the last three months. Participants were recruited between October 1 and December 30, 2021, from four districts of Bagua and Condorcanqui provinces in the Amazonian region. An ad-hoc questionnaire was used to collect information about demographic, economic, and socio-cultural factors and access to health services. The Simplified Medication Adherence Questionnaire (SMAQ) was used to evaluate adherence to antiretroviral therapy. Multivariate logistic regression analysis with backward stepwise was performed to explore factors that might influence adherence.

Results: Of the 208 participants, 28.8% reported complete adherence to antiretroviral treatment. The multivariate logistic regression showed that occupation (aPR: 1.86; 95%CI 1.15-3.02), economic income (aPR: 0.64; 95%CI 0.41-0.99), and adverse reactions to antiretroviral therapy (aPR: 0.36; 95%CI 0.18-0.70) were related to complete adherence to medication.

Conclusion: Only a third of participants reported complete adherence to antiretroviral therapy. Factors associated with adherence to antiretroviral medication were related to socioeconomic conditions and adverse reactions to the therapeutic scheme. Interventions to improve adherence in indigenous people living with HIV should consider these factors in order to develop effective implementation strategies.

References

Graeff S, Picolli R, Arantes R, de Oliveira Landgraf de Castro V, da Cunha R . Epidemiological aspects of HIV infection and AIDS among indigenous populations. Rev Saude Publica. 2019; 53:71. PMC: 6758848. DOI: 10.11606/S1518-8787.2019053000362. View

Bhatti A, Usman M, Kandi V . Current Scenario of HIV/AIDS, Treatment Options, and Major Challenges with Compliance to Antiretroviral Therapy. Cureus. 2016; 8(3):e515. PMC: 4818110. DOI: 10.7759/cureus.515. View

Negin J, Aspin C, Gadsden T, Reading C . HIV Among Indigenous peoples: A Review of the Literature on HIV-Related Behaviour Since the Beginning of the Epidemic. AIDS Behav. 2015; 19(9):1720-34. PMC: 4551545. DOI: 10.1007/s10461-015-1023-0. View

Sianturi E, Perwitasari D, Islam M, Taxis K . The association between ethnicity, stigma, beliefs about medicines and adherence in people living with HIV in a rural area in Indonesia. BMC Public Health. 2019; 19(1):55. PMC: 6330480. DOI: 10.1186/s12889-019-6392-2. View

Zafra-Tanaka J, Ticona-Chavez E . [Stigma related to HIV/AIDS associated with adherence to antiretroviral therapy in patients of a public hospital in Lima, Peru 2014]. Rev Peru Med Exp Salud Publica. 2017; 33(4):625-632. DOI: 10.17843/rpmesp.2016.334.2544. View

Ayer R, Kikuchi K, Ghimire M, Shibanuma A, Pant M, Poudel K . Clinic Attendance for Antiretroviral Pills Pick-Up among HIV-Positive People in Nepal: Roles of Perceived Family Support and Associated Factors. PLoS One. 2016; 11(7):e0159382. PMC: 4954679. DOI: 10.1371/journal.pone.0159382. View

Knobel H, Alonso J, Casado J, Collazos J, Gonzalez J, Ruiz I . Validation of a simplified medication adherence questionnaire in a large cohort of HIV-infected patients: the GEEMA Study. AIDS. 2002; 16(4):605-13. DOI: 10.1097/00002030-200203080-00012. View

Jongbloed K, Pooyak S, Sharma R, Mackie J, Pearce M, Laliberte N . Experiences of the HIV Cascade of Care Among Indigenous Peoples: A Systematic Review. AIDS Behav. 2019; 23(4):984-1003. DOI: 10.1007/s10461-018-2372-2. View

Suryana K, Suharsono H, Antara I . Factors Associated With Adherence To Anti-Retroviral Therapy Among People Living With HIV/AIDS At Wangaya Hospital In Denpasar, Bali, Indonesia: A Cross-Sectional Study. HIV AIDS (Auckl). 2019; 11:307-312. PMC: 6875560. DOI: 10.2147/HIV.S219695. View

10.

Orellana E, Alva I, Carcamo C, Garcia P . Structural factors that increase HIV/STI vulnerability among indigenous people in the Peruvian amazon. Qual Health Res. 2013; 23(9):1240-50. PMC: 4605603. DOI: 10.1177/1049732313502129. View

11.

Bartlett E, Zavaleta C, Fernandez C, Razuri H, Vilcarromero S, Vermund S . Expansion of HIV and syphilis into the Peruvian Amazon: a survey of four communities of an indigenous Amazonian ethnic group. Int J Infect Dis. 2008; 12(6):e89-94. PMC: 2610365. DOI: 10.1016/j.ijid.2008.03.036. View

12.

Johnson M, Dilworth S, Taylor J, Darbes L, Comfort M, Neilands T . Primary relationships, HIV treatment adherence, and virologic control. AIDS Behav. 2011; 16(6):1511-21. PMC: 3607313. DOI: 10.1007/s10461-011-0021-0. View

13.

Ponce P, Munoz R, Stival M . [Indigenous peoples, HIV and public policy in Latin America: an exploration of the current situations of epidemiological prevalence, prevention, care and timely treatment]. Salud Colect. 2018; 13(3):537-554. DOI: 10.18294/sc.2017.1120. View

14.

Al-Dakkak I, Patel S, McCann E, Gadkari A, Prajapati G, Maiese E . The impact of specific HIV treatment-related adverse events on adherence to antiretroviral therapy: a systematic review and meta-analysis. AIDS Care. 2012; 25(4):400-14. PMC: 3613968. DOI: 10.1080/09540121.2012.712667. View

15.

Peltzer K, Pengpid S . Socioeconomic factors in adherence to HIV therapy in low- and middle-income countries. J Health Popul Nutr. 2013; 31(2):150-70. PMC: 3702336. DOI: 10.3329/jhpn.v31i2.16379. View

16.

Pascom A, Meireles M, Benzaken A . Sociodemographic determinants of attrition in the HIV continuum of care in Brazil, in 2016. Medicine (Baltimore). 2018; 97(1S Suppl 1):S69-S74. PMC: 5991540. DOI: 10.1097/MD.0000000000009857. View

17.

Nachega J, Uthman O, Peltzer K, Richardson L, Mills E, Amekudzi K . Association between antiretroviral therapy adherence and employment status: systematic review and meta-analysis. Bull World Health Organ. 2015; 93(1):29-41. PMC: 4271680. DOI: 10.2471/BLT.14.138149. View

18.

Huaman B, Gushiken A, Benites C, Quiroz F, Garcia-Fernandez L . [Prevention of Maternal-Child Transmission of HIV in Pregnant Women and Mothers of the Awajun and Wampis Communities in the Amazon Region of Peru]. Rev Peru Med Exp Salud Publica. 2018; 34(4):627-632. DOI: 10.17843/rpmesp.2017.344.2725. View

19.

Omosanya O, Elegbede O, Agboola S, Isinkaye A, Omopariola O . Effects of stigmatization/discrimination on antiretroviral therapy adherence among HIV-infected patients in a rural tertiary medical center in Nigeria. J Int Assoc Provid AIDS Care. 2013; 13(3):260-3. DOI: 10.1177/2325957413475482. View

20.

Poudel K, Buchanan D, Amiya R, Poudel-Tandukar K . Perceived Family Support and Antiretroviral Adherence in HIV-Positive Individuals: Results from a Community-Based Positive Living With HIV Study. Int Q Community Health Educ. 2015; 36(1):71-91. DOI: 10.1177/0272684X15614220. View