Africans adhere to AIDS drug regimens

Contradicting the perception that AIDS drug regimens are too complicated to be effective in Africa, an international study has found that sub-Saharan Africans are better at taking their drugs than North Americans.

The study, in the current Journal of the American Medical Association, found that 77 percent of sub-Saharan AIDS patients took their drugs correctly compared with 55 percent of North Americans.

"The myth of poor adherence in Africa, previously used as a rationale to delay or deny the expansion of treatment programs ... has firmly been debunked by this study," said Ann-Louise Colgan of Africa Action, an organization that focuses on African issues.

Edward Mills, executive director of the Centre for International Health and Human Rights Studies in Toronto and lead author of the study, said the findings should help end the practice in which patients in Africa are sometimes forced to "prove themselves capable" of following their doctors' orders.

Compliance is critical for anti-retroviral therapy, which typically involves two pills a day in Africa, because not taking the medications correctly can lead to patients developing resistance to the drugs, rendering them ineffective.

Sub-Saharan Africa accounts for 10 percent of the world's population but 79 percent of AIDS deaths. In 2005, an estimated 2.5 million people in the region became newly infected with HIV, the virus that causes AIDS, and 2 million died, according to UNAIDS, the Joint United Nations Program on HIV/AIDS.

One example of the perception that anti-retroviral drug regimens were too complicated to be effective in Africa was a comment in 2001 from the head of the U.S. Agency for International Development that African patients couldn't stick with the treatment because they didn't "know what Western time is."

In 2006, the United States plans to spend $3.2 billion on the global AIDS fight, with $868 million targeted to support anti-retroviral treatment in 15 focus countries, 13 in sub-Saharan Africa.

The study analyzed data from 31 previous studies involving 17,573 North American patients and 27 studies of a total of 12,116 sub-Saharan patients.

Dr. David Bangsberg, an infectious-disease specialist at San Francisco General Hospital and the study's senior author, said even though the drug regimens in North America involve more pills than in Africa, that did not account for the differences in adherence.

Mills said the scarcity of drug treatments in Africa and the big impact the drugs have on generally sicker patients probably makes them more motivated to take their drugs correctly.

In North America, where HIV has largely become a chronic instead of terminal disease, patients may lose vigilance when it comes to taking their medication, the researchers surmised.