FACTORS INFLUENCING ADHERENCE TO ANTIRETROVIRAL THERAPY IN EMBU TEACHING AND REFERRAL HOSPITAL, EMBU COUNTY, KENYA
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Date
2017-03
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Abstract
Adherence to antiretroviral therapy is a major predictor of the survival of individuals
living with HIV/AIDS. Appropriate use of antiretrovirals (ARV’s) has improved the
health of many human immunodeficiency virus (HIV) positive individuals. The
effectiveness of HIV treatment depends on sustenance of high levels of adherence to
ARV; however, ARV regimens are often complicated and can be affected by varying
dosing schedules, failing to have proper dietary requirements and patients developing
adverse effects. The main objective of this study was to determine factors influencing
adherence to Anti-retroviral drugs among HIV and AIDS patients 18 years and above
in Embu Teaching and Referral Hospital comprehensive care clinic. A cross sectional
study was carried out at EmbuTeaching and Referral Hospital in EmbuCounty,
Kenya. Stratified random sampling was used to obtain relative proportion of male and
female adult respondents in the sample population. Three hundred and thirty one HIV
positive patients were chosen from a total of 1694 patients who were active in ART
for more than one year. A semi-structured interview schedules was used to obtain
demographic information and patients view on various dimension or ART services at
the facility. The study revealed thatalmost half (48.2%) of the respondents had
optimal adherence to ART treatment while 51.8% had sub-optimal adherence to ART
treatment. Over a third (34.9%) of the patients indicated that travelling was the main
cause of hindrance to optimal adherence to treatment. Other reasons included
forgetfulness 23.5%, tiredness of taking drugs all the time 20.8% and side effects
20.8%. Patients aged below 25 years were more likely to have optimal ART
adherence as compared to respondents aged 56 years and above (ᵡ
2
=10.745, df=4, pvalue = .030). Monogamously married and polygamous married patients more likely
to have optimal adherence as compared to widowed or widower respondents
(ᵡ
2
=17.944, df=4, p-value = .001). Majority (88.0%) of the respondents had disclosed
their HIV status to other people of whom 46.9% had disclosed to their spouse/sexual
partner and 49.7% of them had been accorded moral support. There was significant
association between adherence to ART and the type of drug respondent was using
with AZT, ddl, NFV having the highest proportion of sub-optimal adherence to
treatment while respondents on D4T, 3TC, NVP had the lowest proportion of suboptimal adherence to treatment. Patients who had sub-optimal ART adherence
significantly had longer waiting time and deemed costs of co-infection treatment to be
higher as compared to respondents who had optimal ART adherence. Convenience of
the facilities for people with chronic ailments and waiting time at the facilities were
reported to be lower. The study concludes that majoritypatients had sub-optimal
adherence to ART treatment. Adherence was significantly influenced by age; marital
status; engagement in income generating activity;type of drug takenand costof coinfection treatment;health facility accessibility and perceived waiting time.The study
recommends that HIV patients should be sensitized on importance of carrying ART
drugs when travelling and the use of treatment assistants to ensure optimal adherence
thus enabling them fully realize its life extending benefits as it has been shown that
there is significant non-adherence among HIV positive patients on ART in the
County.