Objective: To assess the levels of adherence to antiretroviral therapy in a sample of HIV-infected patients from rural areas in China and to determine the factors associated with suboptimal adherence.
Design: A cross-sectional study was conducted on HIV-infected adults receiving free antiretroviral therapy (ART) in two project sites of China's Comprehensive AIDS Response program (China CARES).
Methods: Data on socio-demographic characteristics, ART regimens, HIV/AIDS knowledge, side effects, reasons for missing doses, substance abuse, self-efficacy, doctor-patient relations and health services information was collected through face-to-face interview. The adherence rate was calculated as the number of doses taken divided by the number prescribed over the past three days.
Results: A total of 181 patients participated in the study and 81.8% of them reported > or = 95% adherence on the previous three days. The most frequently reported reasons for missing doses were forgetfulness, being busy and antiretroviral drug side effects. In the multivariate analysis, patients' knowledge about side effects [odds ratio (OR) = 8.08, 95% confidence interval (CI) 2.63-24.81], belief towards ART (OR = 3.20, 95% CI: 1.24-8.26), having developed reminder tools of taking medication (OR = 3.49, 95% CI: 1.36-8.96) and patient' trust and confidence in his/her doctor (OR = 7.79, 95% CI: 1.26-48.95) were independently associated with adherence.
Conclusion: Regular ART adherence education and counseling, improved training on medication self-management skills, improved adherence monitoring and health care services should be priority strategies for improving adherence to ART among HIV/AIDS patients who receive free ART in rural China.