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Adherence to antiretroviral therapy (ART) during the early months of treatment in rural Zambia: influence of demographic characteristics and social surroundings of patients

Yuri Sasaki1*, Kazuhiro Kakimoto2, Christopher Dube3, Izukanji Sikazwe4, Crispin Moyo4, Gardner Syakantu4, Kenichi Komada456, Shinsuke Miyano456, Naoko Ishikawa6, Kiyoshi Kita7 and Ichiro Kai7

Author Affiliations

1 Department of Infection Control and Prevention, Graduate School of Nursing, Nagoya City University, Kawasumi 1, Mizuho-ku, Nagoya-shi, Aichi, 467-8601, Japan

2 School of Nursing, Osaka Prefecture University, 3-7-30, Habikino-shi, Osaka, 583-8555, Japan

3 Mumbwa District Health Office, P.O.Box 830018, c/o Mumbwa, Zambia

4 Ministry of Health, Ndeke House, P.O.Box 30205, Lusaka, Zambia

5 Japan International Cooperation Agency (JICA), Nibancho Center Building 5-25, Niban-cho, Chiyoda-ku, Tokyo, 102-8012, Japan

6 Department of International Medical Cooperation, National Center for Global Health and Medicine (NCGM), 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

7 Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan

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Annals of Clinical Microbiology and Antimicrobials 2012, 11:34  doi:10.1186/1476-0711-11-34

Published: 28 December 2012



Around 70% of those living with HIV in need of treatment accessed antiretroviral therapy (ART) in Zambia by 2009. However, sustaining high levels of adherence to ART is a challenge. This study aimed to identify the predictive factors associated with ART adherence during the early months of treatment in rural Zambia.


This is a field based observational longitudinal study in Mumbwa district, which is located 150 km west of Lusaka, the capital of Zambia. Treatment naive patients aged over 15 years, who initiated treatment during September-November 2010, were enrolled. Patients were interviewed at the initiation and six weeks later. The treatment adherence was measured according to self-reporting by the patients. Multiple logistic regression analysis was performed to identify the predictive factors associated with the adherence.


Of 157 patients, 59.9% were fully adherent to the treatment six weeks after starting ART. According to the multivariable analysis, full adherence was associated with being female [Adjusted Odds Ratio (AOR), 3.3; 95% Confidence interval (CI), 1.2-8.9], having a spouse who were also on ART (AOR, 4.4; 95% CI, 1.5-13.1), and experience of food insufficiency in the previous 30 days (AOR, 5.0; 95% CI, 1.8-13.8). Some of the most common reasons for missed doses were long distance to health facilities (n = 21, 53.8%), food insufficiency (n = 20, 51.3%), and being busy with other activities such as work (n = 15, 38.5%).


The treatment adherence continues to be a significant challenge in rural Zambia. Social supports from spouses and people on ART could facilitate their treatment adherence. This is likely to require attention by ART services in the future, focusing on different social influences on male and female in rural Zambia. In addition, poverty reduction strategies may help to reinforce adherence to ART and could mitigate the influence of HIV infection for poor patients and those who fall into poverty after starting ART.