[Determinants of non-compliance with antiretroviral therapy in adult patients in Kinshasa]. / Déterminants de la non-observance au traitement antirétroviral chez l'adulte à Kinshasa.

INTRODUCTION: the purpose of this study was to identify the determinants of non-compliance of persons living with HIV with antiretroviral treatment in Kinshasa. METHODS: we conducted a cross-sectional study in Kinshasa from 1st May to 31st August 2015. The study population was composed of patients aged at least 18 years living with HIV who had been treated with antiretroviral drugs for at least 3 months. Adherence Index (subjective method) and prescription refills (objective method) were used to assess compliance. Determinants of non-compliance were identified by logistic regression model. RESULTS: the 400 patients living with HIV had a median age of 43 years (18-75). Global non-compliance rate was 25.5%. Objective non-compliance rate was higher than that of subjective non-compliance (29% vs 21%, p = 0.01). Payment for consultation [adjusted odds ratio (AOR): 1.70; 95% confidence interval (95% CI): 1.02-2.81; p = 0.042), adverse reactions (AOR: 2.23; 95% CI: 1.33-3.75; p = 0.002) and the lack of awareness that missing a dose may worsen disease (AOR: 4.16; 95% CI: 1.04-16.68; p = 0.045) were determinants of non-compliance. Having trusted person was a protective factor versus non-compliance (AOR: 0.54; 95% CI: 0.39-0.93; p = 0.004). CONCLUSION: the rate of non-compliance with antiretroviral treatment is high in Kinshasa. The evaluation of determinants is necessary to establish strategies for improving compliance.

Resistance to antiretroviral drugs in treated and drug-naive patients in the Democratic Republic of Congo.

BACKGROUND: We studied virological outcome and drug resistance in patients on antiretroviral therapy (ART) in health care centers in the Democratic Republic of Congo and looked for the presence of drug resistance in antiretroviral-naive patients attending the same clinics. METHODS: In 2008, we conducted a cross-sectional survey among patients on ART for ≥ 12 months in 4 major cities [Kinshasa (n = 289), Matadi (n = 198), Lubumbashi (n = 77), and Mbuji-Mayi (n = 103)]. Genotypic drug resistance tests were done with an in-house assay on samples with viral load >1000 copies/mL. ART-naive patients (n = 283) were also consecutively enrolled in the same clinics. RESULTS: Of the 667 patients on ART, >98% received Lamivudine + Stavudine/azidothymidine + Nevirapine/Efavirenz as first-line regimen and 74.4% were women. Median time on ART was 25 months [interquartile ratio (IQR), 19-32] in Kinshasa, 26 months (IQR, 19-32) in Matadi, 27 months (IQR, 19-44) in Lubumbashi, and 19 months (IQR, 16-24) in Mbuji-Mayi. A total of 97 patients (14.6%) had viral load >1000 copies/mL, and among the 93 successfully sequenced samples, 78 (83.9%) were resistant to at least 1 drug of their ART regimen: 68 harbored resistance mutations to nucleoside reverse transcriptase inhibitor (NRTI) and nonnucleoside reverse transcriptase inhibitor (NNRTI), 2 to NRTI only, 7 to NNRTI only, and 1 to NRTI + NNRTI + protease inhibitor. The majority of patients, 70/78 (89.7%), were resistant to at least 2 of the 3 drugs from their treatment. The use of next-generation NNRTI, etravirine was already compromised for 19.2% (15/78) of the patients and 7 patients had the K65R mutation compromising the use of tenofovir in second-line regimens. The proportion of antiretroviral-resistant patients increased over time from 8.4% to 18.6% for patients on ART for 12-23 months or >35 months (P = 0.013), respectively. Virological failure and rates of drug resistance were significantly higher among men than women, 19.9% versus 8.8%, respectively (P = 0.0001). Among the 253 recently diagnosed patients, 20 (7.9%) harbored resistance mutations. CONCLUSIONS: The accumulation of drug resistance mutations with time on ART needs further attention, and surveillance should be reinforced in ART programs in sub-Saharan Africa.