Background: Optimal adherence to an

Background: Optimal adherence to antiretroviral therapy (ART) is necessary for people living with HIV/AIDS (PLHIV).
There have been relatively few systematic analyses of factors that promote or inhibit adherence to antiretroviral
therapy among PLHIV in Asia. This study assessed ART adherence and examined factors associated with suboptimal
adherence in northern Viet Nam.
Methods: Data from 615 PLHIV on ART in two urban and three rural outpatient clinics were collected by medical
record extraction and from patient interviews using audio computer-assisted self-interview (ACASI).
Results: The prevalence of suboptimal adherence was estimated to be 24.9% via a visual analogue scale (VAS) of
past-month dose-missing and 29.1% using a modified Adult AIDS Clinical Trial Group scale for on-time dose-taking
in the past 4 days. Factors significantly associated with the more conservative VAS score were: depression (p <
0.001), side-effect experiences (p < 0.001), heavy alcohol use (p = 0.001), chance health locus of control (p = 0.003),
low perceived quality of information from care providers (p = 0.04) and low social connectedness (p = 0.03). Illicit
drug use alone was not significantly associated with suboptimal adherence, but interacted with heavy alcohol use
to reduce adherence (p < 0.001).
Conclusions: This is the largest survey of ART adherence yet reported from Asia and the first in a developing
country to use the ACASI method in this context. The evidence strongly indicates that ART services in Viet Nam
should include screening and treatment for depression, linkage with alcohol and/or drug dependence treatment,
and counselling to address the belief that chance or luck determines health outcomes