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AIDS Research and Treatment
Volume 2017, Article ID 5456219, 6 pages
Research Article

Evaluating Adherence to Antiretroviral Therapy Using Pharmacy Refill Records in a Rural Treatment Site in South Africa

1HIV/AIDS & Global Health Research Programme, University of Venda, Thohoyandou, South Africa
2Department of Medical Laboratory Sciences, Kenyatta University, Nairobi, Kenya
3Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
4Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, VA, USA
5HIV/AIDS Prevention Group Wellness and Health Clinic, Bela Bela, South Africa

Correspondence should be addressed to Pascal O. Bessong;

Received 28 September 2016; Accepted 12 January 2017; Published 31 January 2017

Academic Editor: Robert R. Redfield

Copyright © 2017 George Gachara et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Optimal adherence to combination antiretroviral therapy (cART) is critical to maintain virologic suppression, thereby ensuring the global success of HIV treatment. We evaluated adherence to cART using pharmacy refill records and determined the adherence threshold resulting in >90% virologic suppression in a community run treatment site in South Africa. Additionally, we analysed factors associated with adherence using univariable and multivariable logistic regression models. Logistic regression was also performed to determine the relationship between adherence and virologic suppression and the adherence threshold resulting in <10% virologic failure. The overall median (interquartile range) adherence was 95% (88.6–98.4%). Out of the study participants, 210/401 (52.4%) had optimal (≥95%) adherence while only 37/401 (9.2%) had poor (≤80%) adherence. The majority (90.5%) of patients with optimal adherence had virologic suppression. Having TB at registration into care was found to be negatively associated with adherence (adjusted odds ratio [AOR], 0.382; ). Compared to nonadherent individuals, optimally adherent participants were more likely to achieve virologic suppression (OR 2.92; 95% CI: 1.63–5.22). Only adherence rates above 95% were observed to lead to <10% virologic failure. cART adherence measured by pharmacy refill records could serve as a useful predictor of virologic failure; adherence rates >95% are needed to maintain optimal virologic suppression.