Reasons for missing antiretroviral therapy: results from a multi-country study in Tanzania, Uganda, and Zambia

Olivier Koole, J.A. Denison, Joris Menten, S. Tsui, F. Wabwire-Mangen, G. Kwesigabo, M. Mulenga, A. Auld, S. Agolory, Y.D. Mukadi, E. Van Praag, K. Torpey, S. Williams, J. Kaplan, A. Zee, D.R. Bangsberg, R. Colebunders

Research output: Contribution to journalA1: Web of Science-articlepeer-review

17 Downloads (Pure)


OBJECTIVES: To identify the reasons patients miss taking their antiretroviral therapy (ART) and the proportion who miss their ART because of symptoms; and to explore the association between symptoms and incomplete adherence. METHODS: Secondary analysis of data collected during a cross-sectional study that examined ART adherence among adults from 18 purposefully selected sites in Tanzania, Uganda, and Zambia. We interviewed 250 systematically selected patients per facility (>/=18 years) on reasons for missing ART and symptoms they had experienced (using the HIV Symptom Index). We abstracted clinical data from the patients' medical, pharmacy, and laboratory records. Incomplete adherence was defined as having missed ART for at least 48 consecutive hours during the past 3 months. RESULTS: Twenty-nine percent of participants reported at least one reason for having ever missed ART (1278/4425). The most frequent reason was simply forgetting (681/1278 or 53%), followed by ART-related hunger or not having enough food (30%), and symptoms (12%). The median number of symptoms reported by participants was 4 (IQR: 2-7). Every additional symptom increased the odds of incomplete adherence by 12% (OR: 1.1, 95% CI: 1.1-1.2). Female participants and participants initiated on a regimen containing stavudine were more likely to report greater numbers of symptoms. CONCLUSIONS: Symptoms were a common reason for missing ART, together with simply forgetting and food insecurity. A combination of ART regimens with fewer side effects, use of mobile phone text message reminders, and integration of food supplementation and livelihood programmes into HIV programmes, have the potential to decrease missed ART and hence to improve adherence and the outcomes of ART programmes.
Original languageEnglish
Article numbere0147309
JournalPLoS ONE
Issue number1
Number of pages15
Publication statusPublished - 2016


  • Viral diseases
  • HIV
  • AIDS
  • Antiretrovirals
  • Compliance
  • Retention
  • Loss to follow-up
  • Symptoms
  • Gender
  • CD4 lymphocyte count
  • Regimens
  • Tanzania
  • Uganda
  • Africa-East
  • Zambia
  • Africa-West


Dive into the research topics of 'Reasons for missing antiretroviral therapy: results from a multi-country study in Tanzania, Uganda, and Zambia'. Together they form a unique fingerprint.

Cite this