الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
HIV is a retrovirus, that infects cells of the immune system, leading to AIDS, a condition by which the immune system begin to fail, causing life threatening opportunistic infection and death.
AIDS has now become the worst pandemic in human history. WHO estimated that there were 36.7 million PLHIV worldwide by the end of 2015. In MENA region there were 230,000 and in Egypt there were 3% of the total PLHIV in the MENA region, concentrated mainly in Cairo and Alexandria.
Advances in ART have changed the nature of HIV/AIDS disease, and led to increase of the number of PLHIV cases. Strict adherence to ART have long been considered a cornerstone in the successful management of HIV disease, and strong predictor of virologic and immunologic response.While Decrease in adherence increase the risk of ART resistance and viral rebound, and poses a growing public health threat due to development of treatment resistant virus strains.
The present study aimed to:
1.Assess the effect of ART adherence on change of CD4 cell count and HIV load.
2.Find out the relation between the HIV load and CD4 cell count in different ART adherence situations.
3. Identify the main barriers affecting ART adherence among PLHIV.
The current study was carried out on PLHIV attending HIV clinic in Alexandria Fever Hospital, during their 6 months treatment period from May 2016 to May 2017.
This study included:
Thirty PLHIV, aged 18 years or older, whose CD4 counts just reached below 500 cell/mm3and where selected to start ART were included in the study. Viral load and CD4 counts were measured for each patient before starting ART and after six months of the treatment. A full questionnaire was filled by each patient including all the relevant information.Pharmacy records containing frequency and quantity of ART dispensed at study period were collected after 6 months of the treatment.
The factor found to participate in non-adherence to ART fall into four main categories: patient-related factors, factors related to the treatment regimen, patient-provider relationship, and factors related to health care delivery system.
The results of this study showed that:
1.Sixty percent of enrolled patients in this study were adherent to ART, had significant (p≤0.01) decrease in viral load, andincrease in CD4 countafter 6 months treatment period.
2.The remaining non-adherent patients to ART, had nodifference (p>0.01) between initial and after 6 months viral load CD4 count.
3.For patients related barriers, non-adherence to ART was significantly(p≤ 0.01) associated with patients that were: unemployed, substance abusers, feeling depressed and their education level less than high school
4.ents who experienced treatment side effects, changed their treatment line, those who were admitted to hospital in past six months, and patients who had comorbidities.
5.For health care provider barriers,non-adherence to ART was statistically significant (p ≤ 0.01) associated with patients who had the following characteristics: doctor wasn’t friendly with them and didn’t receive reassurance from doctor and doctor didn’t give attention to what they said and doctor didn’t spend enough time with them and doctor didn’t probably explain the medical procedure to them.
6.For health care system barrier,non-adherence to ART was statistically significant (p ≤ 0.01) associated with patients who weren’t satisfied by the accessibility, patients who didn’t find the clinic serving hours convenient, and those who weren’t satisfied by privacy at the facility.
7.The most common reasons the patients reported for non-adherence to ART was lack of education about drug resistance and its relationship to poor adherence..
It was concluded from the study that:
1.Strict adherence and deal with barriers associated with non-adherence to treatment are mandatory to ensure successful virologic and immunologic response among PLHIV.
2.Several barriers about patients attributes, treatment related factors, patient- provider relationship and health care delivery system,were statistically significant associated with non-adherence to ART.
3.The most common reasons PLHIVreportedfor non-adherence to ARTwas lack of health education about drug resistance and its relationship to poor adherence.