Publication: Forgetting to Take Medication, Treatment Adherence and Their Relationship with Viral Load Suppression Among People Living with HIV in the Kilimanjaro Region, Tanzania

Lyidia V Masika,1,2 Innocent B Mboya,1,3 Rehema Anenmose Maro,2 Benson Mtesha,2 Mtoro J Mtoro,1 Kennedy Ngowi,2 Michael Johnson Mahande,1,4 I Marion Sumari-de Boer1,2,5

HIV/AIDS remains a significant public health concern, with approximately 37.7 million cases globally, 84% of which are in sub-Saharan Africa. Tanzania's HIV prevalence is 4.5%, with the Kilimanjaro region at 2.6%. In 2020, Tanzania reported around 58,000 new infections among people aged 15-49 and 8,600 among children aged 0-14. The government has implemented policies to combat the HIV epidemic, focusing on improving access to HIV testing and ART, reducing mother-to-child transmission, and providing education and free condoms. Achieving global targets for HIV involves ensuring viral suppression among those on ART.

Medication adherence, defined by the WHO as the extent to which patients follow instructions, is crucial for treatment success. Good adherence is considered taking at least 90-95% of prescribed medication. Poor adherence, often due to forgetting, stigma, depression, and side effects, leads to detectable viral loads. A systematic review reported that forgetting to take medication is prevalent among adults (41.1%), adolescents (40.7%), and children (29.2%). In Tanzania, studies indicate that forgetting medication contributes to detectable viral loads.

Monitoring adherence includes methods like pill counts and pharmacy refill counts, though these have limitations. The WHO recommends Digital Adherence Tools (DAT) to remind patients to take their medication, which have shown effectiveness across various conditions. Understanding the impact of forgetting medication on viral suppression can inform intervention strategies.

This mixed-methods study, part of the REMIND-KID project, was conducted from September 2021 to March 2022 in Kilimanjaro, Tanzania. Participants included children, adolescents, and pregnant/breastfeeding women living with HIV, attending care and treatment clinics. The study aimed to assess the extent to which missed medication is due to forgetting and its relationship with detectable viral loads.

Data collection involved structured questionnaires, in-depth interviews, and focus group discussions. Quantitative data were analyzed using logistic regression models, while qualitative data were analyzed thematically. The main outcome was a detectable viral load, defined as above 20 copies/mL of blood.

The study enrolled 427 participants: 142 pregnant/breastfeeding women, 143 adolescents, and 142 children with their caregivers. Among these, 97 (22.3%) reported missing medication, with 72 (17.9%) attributing it to forgetfulness. The main reasons for forgetting included lack of reminders and being busy.

Forgetting to take medication was significantly associated with a detectable viral load (AOR: 1.75). Other factors included being on second-line treatment and male gender. The study highlights the importance of reminders, such as SMS, to improve adherence and suggests that addressing forgetfulness can enhance viral suppression efforts.

The study shows that, improving adherence through reminders and addressing barriers like forgetfulness and depression is essential for achieving viral suppression and combating the HIV epidemic.

To read more kindly follow the link: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11192192/