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We compared levels and determinants of adherence over time between HIV\u2010positive persons receiving ART who were enrolled in a bi\u2010regional cohort in sub\u2010Saharan Africa and Asia.<\/jats:p><jats:p><jats:bold>Methods<\/jats:bold>: This multicentre prospective study of adults starting first\u2010line ART assessed patient\u2010reported adherence at follow\u2010up clinic visits using a 30\u2010day visual analogue scale. Determinants of suboptimal adherence (&lt;95%) were assessed for six\u2010month intervals, using generalized estimating equations multivariable logistic regression with multiple imputations. Region of residence (Africa vs. Asia) was assessed as a potential effect modifier.<\/jats:p><jats:p><jats:bold>Results<\/jats:bold>: Of 13,001 adherence assessments in 3934 participants during the first 24\u00a0months of ART, 6.4% (837) were suboptimal, with 7.3% (619\/8484) in the African cohort versus 4.8% (218\/4517) in the Asian cohort (<jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). In the African cohort, determinants of suboptimal adherence were male sex (odds ratio (OR) 1.27, 95% confidence interval (CI) 1.06\u20131.53; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.009), younger age (OR 0.8 per 10\u00a0year increase; 0.8\u20130.9; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.003), use of concomitant medication (OR 1.8, 1.0\u20133.2; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.044) and attending a public facility (OR 1.3, 95% CI 1.1\u20131.7; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.004). In the Asian cohort, adherence was higher in men who have sex with men (OR for suboptimal adherence 0.6, 95% CI 0.4\u20130.9; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.029) and lower in injecting drug users (OR for suboptimal adherence 1.6, 95% CI 0.9\u20132.6; <jats:italic>p<\/jats:italic>\u00a0=\u00a00.075), compared to heterosexuals. Risk of suboptimal adherence decreased with longer ART duration in both regions. Participants in low\u2010 and lower\u2010middle\u2010income countries had a higher risk of suboptimal adherence (OR 1.6, 1.3\u20132.0; <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001), compared to those in upper\u2010middle or high\u2010income countries. Suboptimal adherence was strongly associated with virological failure, in Africa (OR 5.8, 95% CI 4.3\u20137.7; <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001) and Asia (OR 9.0, 95% CI 5.0\u201316.2; <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Patient\u2010reported adherence barriers among African participants included scheduling demands, drug stockouts, forgetfulness, sickness or adverse events, stigma or depression, regimen complexity and pill burden.<\/jats:p><jats:p><jats:bold>Conclusions<\/jats:bold>: Psychosocial factors and health system resources may explain regional differences. Adherence\u2010enhancing interventions should address patient\u2010reported barriers tailored to local settings, prioritizing the first years of ART.<\/jats:p>","DOI":"10.7448\/ias.20.1.21218","type":"journal-article","created":{"date-parts":[[2017,4,5]],"date-time":"2017-04-05T13:43:11Z","timestamp":1491399791000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":71,"title":["Adherence to antiretroviral therapy for HIV in sub\u2010Saharan Africa and Asia: a comparative analysis of two regional cohorts"],"prefix":"10.1002","volume":"20","author":[{"given":"Rimke","family":"Bijker","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Awachana","family":"Jiamsakul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cissy","family":"Kityo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sasisopin","family":"Kiertiburanakul","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margaret","family":"Siwale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praphan","family":"Phanuphak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sulaimon","family":"Akanmu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Romanee","family":"Chaiwarith","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ferdinand W","family":"Wit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedict LH","family":"Sim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tamara Sonia","family":"Boender","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rossana","family":"Ditangco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias F","family":"Rinke De Wit","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annette H","family":"Sohn","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raph L","family":"Hamers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,1]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"vol.","author":"UNAIDS.","year":"2016"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/QAD.0b013e32832ba8ec"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00002030-200106150-00015"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12916-014-0142-1"},{"key":"e_1_2_13_6_1","doi-asserted-by":"crossref","first-page":"e438","DOI":"10.1371\/journal.pmed.0030438","article-title":"Adherence to HAART: a systematic review of developed and developing nation patient\u2010reported barriers and facilitators","volume":"2006","author":"Mills EJ","year":"2006","journal-title":"Plos Medicine."},{"key":"e_1_2_13_7_1","volume-title":"90\u201090\u201090. 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