Non-adherence to medication threatens Cambodia’s zero AIDS deaths target

The Cambodian Government has committed to reaching zero AIDS-related deaths by 2020. But the number of deaths among people who are living with HIV continues to rise.

The Cambodian Government has committed to reaching zero AIDS-related deaths by 2020. But the number of deaths among people who are living with HIV continues to rise, despite the fact that antiretroviral treatment is more widely available.

One reason for this is because some people living with HIV are missing follow-up hospital appointments and failing to adhere to antiretroviral treatment.

In April 2014, UNAIDS reported an HIV prevalence of 0.7 per cent in Cambodia and a total of 73,433 people who are living with HIV, based on figures from the National Centre for HIV and AIDS, Dermatology and STDs (NCHADS). In the same year, there were 2,229 AIDS-related deaths among adults, showing a slight increase on the 2012 figure of 1,917.

According to NCHADS, 55,468 patients were taking pre-antiretroviral or anti-retroviral treatment in 2013. Antiretroviral retention (people who adhere to treatment) stood at 85 per cent after 12 months, however this fell to 75 per cent after five years.

Health impacts of non-adherence

Dr Men Pagnaroat, medical advisor on antiretroviral therapy at Koh Samah referral hospital, said: “Before putting a patient on antiretrovirals, we have to inform them about the side effects, benefits and the consequences of non-adherence. Both the medical doctor and the counsellor do this. During follow-up appointments, we continue to stress the importance of adherence to the treatment.”

According to Dr Pagnaroat, the impact of non-adherence on the patient’s health depends on the length of time since they abandoned antiretroviral therapy, as well as the level of infection-fighting white blood cells (CD4s) in their blood before they stopped taking the drugs.

“Over time, their CD4 level will drop and their viral load [the level of HIV in their blood] will increase. Resistance to some antiretrovirals could also happen if the patients do not stop therapy appropriately,” he said.

Migration disrupts treatment

Mr Suem Sophal, who has lived with HIV for a long time, said: “Lots of people living with HIV are forced to migrate to other countries near Cambodia, or to other provinces, to find a job to support their family. When they become very sick, they sometimes have to borrow money from their neighbours to pay for treatment. Although their health becomes better once they start taking antiretrovirals, they must travel far away from home to earn money to pay back the debt. This means they often miss their treatment for four or five months.”

He continued: “When people living with HIV received food support from the World Food Programme, it was easier for them to adhere to their treatment. Fewer people had to migrate because they had food for their daily life and were able to send their children to school. Unfortunately, the number of people living with HIV who are missing their antiretroviral treatment has increased since food support ended in 2012.

“There are also still some operational districts which are located far from the towns, with a limited number of doctors to provide consultations to people living with HIV. Specialist doctors are not handing over their knowledge to others while they are busy.”

An official from the National AIDS authority said: “The death of people living with HIV who are on antiretroviral therapy is still a big concern for us as decision-makers. Although coverage is high, the death rate is also still high. This raises questions around quality of care and staff turnover.”

Read more about HIV and the post 2015 development agenda