Louise Binder, chair of the Canadian Treatment Action Council, spoke to Canada AM Wednesday.

Many HIV Canadians not following drug plan: study

CTV.ca News Staff

Canadians infected with HIV are less likely to follow instructions when taking anti-HIV medications than those in sub-Saharan Africa, a new Canadian-led study suggests.

In an analysis of almost 60 studies on medication compliance during the past decade, researchers found that just 55 per cent of North Americans HIV patients followed their anti-retroviral medication (ART) regimens to the letter, compared with 77 per cent of their counterparts in sub-Saharan Africa.

To suppress the HIV virus, many patients need to follow a complicated ART regimen, which can include various doses and dietary restrictions, whilst at the same time deal with side-effects of the medication such as fatigue, nausea, vomiting, diarrhea, weight gain and skin rashes.

Some health organizations previously feared that poor African patients without a formal education would not follow the ART regimen properly.

Principal author of the study, Ed Mills, of the Centre for International Health and Human Rights Studies in Toronto, said the findings threw out the theory that giving drugs to Africans struggling with poverty and low education levels may be ineffective because they will not take the drug doses as prescribed.

"If the assumption by international agencies was and continues to be that adherence in Africa is going to be poor, and therefore they should limit access to treatment, the current evidence doesn't support that," he said in the study.

In North America, reasons for low compliance rates appear to include poor relationships between doctors and patients, depression and alcohol and drug abuse, rather than poverty itself.

The study suggest that HIV-infected Canadians and Americans need health providers to determine why they are not sticking to their drug regimen and to provide them help to stay the course.

"We need to engage with patients more and learn what patients are thinking about the drugs, what patients would like to help them improve adherence, and physicians need to actively discuss these issues with their patients," the study says.

Louise Binder, chair of the Canadian Action Treatment Council, said many North Americans on anti-retroviral therapy are suffering from "pill fatigue," in part because of the numbers they must take daily and the fact they are lifelong medications.

Side-effects from the drugs lead many people to take drug holidays now and again, she said.

Others simply forget doses or, in the case of some single mothers, find it impossible to stick to the regimen because of juggling children and a job.

"You have so many other responsibilities that adherence can become a big problem," she said.

Appearing on CTV's Canada AM Wednesday, Binder said there needed to be a greater focus on prevention in North America, particularly among women and girls.

"There is just still a terrible lack of education among people," she told AM. "We need to find places where young women congregate and we need to be targeting prevention among them."

The researchers looked at data involving about 17,000 HIV-infected patients in North America and about 12,000 in sub-Saharan Africa.

Results of the study appeared in Wednesday's issue of the Journal of the American Medical Association.

The research received funding from the Ontario and federal governments, as well as the National Institutes of Health in the U.S., and the Doris Duke Charitable Foundation.

The results of the study were published as thousands of scientists, advocates and policy-makers prepared to meet in Toronto this weekend for the 16th International AIDS Conference.