Wang and Wu recently assessed the levels of adherence to antiretroviral therapy in a sample of HIV-infected patients from rural China to determine the factors associated with nonadherence. A cross-sectional study was conducted on HIV-infected adults who received free antiretroviral therapy (ART) in two project sites of China's Comprehensive AIDS Response program (China CARES). Data on socio-demographic characteristics, ART regimens, HIV/AIDS knowledge, side effects, reasons for missing doses, substance abuse, self-efficacy, doctor-patient relations, and health services information were collected through face-to-face interviews. Adherence rate was calculated as the number of doses taken divided by the number prescribed over the past three days. A total of 181 patients participated in the study, and 81.8% of them reported 95% or greater adherence on the previous three days. The most frequently reported reasons for missing doses were forgetfulness, being busy, and drug side effects. In the multivariate analysis, patients' knowledge about side effects, belief towards ART, having developed reminder tools of taking medication, and patient' trust and confidence in his/her doctor were independently associated with adherence.

VALUE OF STUDY TO READER: Wang and Wu found that regular ART adherence education and counseling, improved training on medication self-management skills, improved adherence monitoring. and health care services improved adherence to HIV/AIDS regimens in China. They suggested that self-management be priority strategies for improving adherence to ART among HIV/AIDS patients who receive free ART in rural China. We enthusiastically concur with these conclusions. In addition, health officials in China should be applauded for developing and implementing self-management strategies for HIV/AIDS. In too many countries, this approach is eschewed in favor of the health provider control via direct-observation therapy (DOT). The study suggests that self-management should be the basic control tactic for HIV/AIDS and not DOT.

X Wang, Z Wu. Factors associated with adherence to antiretroviral therapy among HIV/AIDS patients in rural China. AIDS, 2007;21 Suppl 8:S149-S155.