Participants were clinically evaluated and interviewed regarding their adherence to ART pre-travel and post-travel, international border passage with selleck kinase inhibitor medications and reasons for missing ART doses. Post-travel change in CD4 counts and RNA-PCR viral load were measured. Outcomes were proportion who missed ≥1 dose of ART during Hajj compared with pre-travel or post-travel and failure of ART, defined as decline in CD4 cell counts or high viral load or both. Results. Thirty-one HP and 27 NP had similar characteristics and were away for (median [range]) 36 days (28–43

days) and 84 days (28–84 days), respectively (p < 0.0001). Those who missed ≥ 1 ART doses among HP and NP while away were 16/31 (51.6%) and 5/27 (18.5%), respectively with risk ratio (95% confidence interval [CI]) 2.79 (1.18–6.60). Among HP, the proportions who missed ≥ 1 ART doses pre-travel and post-travel were lower than those who missed it during Hajj. Those who failed ART among HP compared with NP were 15/31 (48.4%) and 5/27 (18.5%), respectively with odds ratio (95% CI) 4.13 (1.10–17.21). Reasons for missing ART included forgetfulness, exhaustion of supplies, stigma, spiritual alternatives, or disinclination; ZD1839 chemical structure five patients were unable to cross airports with medications. Conclusions. Patients who went on Hajj were more likely to miss medications and to have ART failure due to several reasons including inability

to cross borders with medications. Annual Hajj pilgrimage to Mecca in Saudi-Arabia is a fundamental

religious rite in Islam that is observed by Muslims throughout the world at least once in a lifetime. It is an annual mass gathering with a congregation of over 2.5 million people that takes days to weeks during the 11th to 12th months of the Islamic lunar calendar.1,2 Many countries with considerable burden of human immunodeficiency virus (HIV) infection in Africa and Asia also have substantial Muslim populations. With massive and rapid anti-retroviral therapy (ART) expansion,3,4 infected patients on ART might be able to go for the Hajj. But to succeed, its provision and expansion should adapt to cultural and religious practices like Hajj.5 Its sustained effectiveness depends on long-term, regular, fixed interval, and time-specific dosing schedules Thalidomide that ensure drug concentrations are consistently high.6,7 However, infected Hajj-pilgrims (HP) encounter some challenges regarding adherence to ART. Firstly, they travel from their countries crossing national boundaries to another country where passage with medications might prove difficult. Secondly, the circumstances, mobility, and overcrowding with strong potential for stigma, and the rigorous rites might compromise adherence to ART.1,2 Thus, consequent suboptimal adherence might lead to reduced effectiveness, therapeutic failure, emergence of resistance, and potential transmission of drug-resistant virus strains within the global community.