As the world health community grapples with how to deliver AIDS drugs to Africa, new surveys show that African patients adhere to various anti- HIV medication regimens at least as well as those in developed nations. A survey of 289 patients in Cape Town, South Africa, published this month (AIDS 2003; 17: 1369-75), found that median adherence to anti-HIV regimens was 93·5%, verified by clinic-based pill count.

David Bangsberg (University of California, San Francisco) and colleagues found that 31 patients in Kampala, Uganda, were taking 90-94% of their medications (presented at the July International AIDS Society meeting). Two other studies — by Médecins Sans Frontières, of 550 patients in Khayelitsha, and another, of 58 patients in Senegal (AIDS 2002; 16: 1363-70) — had similar findings. Estimates in developed nations are around 70%.

Part of what may drive the high levels of adherence is, paradoxically, extreme poverty.

"I think the assumption that poverty leads to low levels of adherence is just incorrect", Bangsberg said. "We've heard anecdotal stories of patients vomiting up pills, washing them off, and taking them again."

Jeffrey Stringer (University of Alabama at Birmingham, USA, and Centre for Infectious Disease Research, Zambia) and colleagues have started a small study in Zambia.

Initial results show all participants are taking greater than 90% of their medicines.

Stringer told The Lancet that "high rates of antiretroviral adherence are clearly possible in African settings, and while the unique set of issues around adherence to medication in African populations should be considered carefully as we design antiretroviral treatment programmes, it in no way should delay large-scale implementation." - Ivan Oransky