Background: The Democratic Republic of Congo (DRC) has committed to reaching 70% antiretroviral therapy (ART) coverage in 2018, but the effectiveness of lifesaving HIV treatment is dependent on patient adherence. Understanding adherence patterns, including sex differences, is critical to designing effective adherence support interventions as part of HIV treatment programs.
Methods: This analysis aimed to identify demographic and geographic correlates of ART adherence, and used aggregate data from 151 ICAP-supported sites in Kinshasa and Haut-Katanga provinces in DRC, collected from 2015-2017. The aggregate data was originally collected from ART registers at ICAP-supported sites. Adherence interventions in these facilities included adherence clubs, support groups, buddy systems using mobile apps, and adolescent groups that discuss barriers to adherence. Using logistic regression, we analyzed whether adherence is associated with sex, province, and age group in the first 12 months of treatment.
Results: Between January 1, 2015 and December 31, 2016, 7,346 adolescents (ages 15-19) and adults (ages 20 and over) newly initiated ART. Between March 1 2016 and December 31 2017, 4,405 (60%) patients had reached 12 months on treatment and self-reported as adherent. In an initial multivariable analysis, interaction was found between sex and province, and age group and province, so all further analyses were stratified by province. When controlling for age group, males in Kinshasa were less likely than females to be adherent in the first twelve months on treatment [adjusted odds ratio (AOR)=0.75, 95% CI=0.66-0.86)]. No difference was found between adolescents and adults (AOR=1.48, 95% CI=0.99-2.19). In Haut-Katanga, no difference was found between males and females (AOR=1.13, 95% CI=0.95-1.35). In Haut-Katanga, adolescents were more likely than adults to be adherent (AOR=4.58, 95% CI=2.22-9.47).
Conclusions: Differences between Haut-Katanga versus Kinshasa might be connected to overall higher socioeconomic status in Haut-Katanga, a result of the many precious stone mines in the region. Additionally, psychosocial support services targeted to adolescents in Haut-Katanga might explain age group differences in adherence. Option B+ for prevention of mother to child transmission of HIV provides an avenue for many newly initiated women to receive enhanced support, which might explain sex differences in Kinshasa.