Citation: Maier M, Bwana M, Emenyonu N, Pepper L, Bangsberg DR (2006) How to Take HIV Antiretroviral Medications on Time without a Watch in Rural Uganda. PLoS Med 3(3): e161. doi:10.1371/journal.pmed.0030161
Published: March 28, 2006
Copyright: © 2006 Maier et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Competing interests: The authors have declared that no competing interests exist. All procedures were approved by the Mbarara University of Science and Technology Human Subjects Committee, University of California Human Subjects Committee, and the Ugandan National Council of Science and Technology. Funding was provided by NIMH 54907, NIAAA 15287, UCSF-GIVI Fogarty, and The Doris Duke Charitable Foundation.
Castro has advocated that adherence to HIV antiretroviral therapy should be understood within a patient's clinical and social context . Over 90% of worldwide HIV infection occurs in resource-limited settings . Some have suggested that individuals living in extreme poverty may have difficulties with adherence to medication , including Andrew Natisios, who said Africans “don't know what Western time is” . While recent reports suggest that adherence to HIV antiretroviral therapy in resource-limited settings may be as good as or better than resource-rich settings [5–7], the question remains: how do people take medications on time without a watch?
In rural western Uganda, there is, for example, a 40-year-old man who is HIV-positive, has no education, and works as a farmer. He lives with his brother, sister-in-law, and three nieces in a three-room, mud-walled house without electricity. He owns a lantern, a bed, a sofa, a bike, and a radio, but does not own a watch. He was diagnosed with HIV in April 2005 and started generic D4T/3TC/NVP (Triomune) four months after developing disseminated herpes zoster and Kaposi sarcoma with a CD4 count of 151. His adherence was measured with an electronic medication monitor that records a date-time stamp in flash memory each time the pill container is opened. Over the 89 days of monitored treatment, he had 98.9% adherence by electronic monitor and took 90% of prescribed doses within ten minutes of 7:20 a.m. and within 17 minutes of 7:20 p.m. When asked how he knew when to take his dose, he said that he knows it is time to take his medications by “listening to Radio West's ‘News and Announcements’ every morning and evening.”
Electronic medication monitor adherence record of time of bottle openings for morning and evening dosesdoi:10.1371/journal.pmed.0030161.g001
Patient with his radiodoi:10.1371/journal.pmed.0030161.g002
While population levels of adherence will likely drop as treatment access expands and people begin to experience toxicities of long-term therapy, he is an example of how patients can have precise, if not perfect, adherence with creative solutions in a resource-limited setting.
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