Abstract:
The rollout of antiretroviral therapy (ART) significantly reduced human HIV-related morbidity and mortality, however good clinical outcomes depend on access and adherence to treatment. In resource-limited settings, where over 90% of the world’s HIV-infected population resides, data on barriers to treatment is emerging that contribute to low rates of uptake in HIV testing, linkage to HIV care systems, and sub-optimal adherence rates to therapy. Sub-optimal adherence predicts virological failure, the development of HIV drug resistance and death. Therefore, standardized, simple, and routine cost-effective monitoring of adherence is necessary to identify patients at risk. The objective of this study was to determine the factors influencing adherence to Anti-retroviral therapy among patients attending the CCC at JKUAT, by a descriptive cross-sectional. Systematic random sampling was used to identify the respondents. Data was collected using semi structured questionnaires. Three FGDs with between eight to ten members were conducted. Data was analyzed using SPSS version 16 where descriptive data was analyzed using means and proportions. Association between independent and dependent variables was assessed using Chi square. Differences in parameter of estimates were deemed significantly different at P< 0.05. Overall 300 participants were enrolled for the study. Of these, 70% were females and 30% were males. Results indicated that although respondents had knowledge on importance to adhere, only 81% adhered to ARV treatment; a rate which is below the optimum adherence of 95%. There was a significant association between support (encouragement and reminder to take drugs) and adherence (P=0.025) with patients who received social support being more adherent to ARVs, as compared to non- supported respondents. There was a significant association between the number of meals taken in a day and adherence (p = 0.001). Participants who could afford only one meal per day were 7 times less likely to adhere than those who could afford 3 meals. There was a significant relationship between pill burden and adherence to ARV (p = 0.002). Respondents who took their medication only once per day were more likely to adhere in comparison to those who took their ARV drugs more than once in a day. There was no significant relationship between adherence and age, marital status, education, employment status or time taken to travel to the clinic. This study concluded that, the observed level of sub-optimal adherence to ART (19%) is of public health concern. These patients are vulnerable to treatment failure and development of resistant viral strains. This study recommends to the MOH that, there is need for intensification of public education against stigma in HIV and promotion of family and community support to the HIV infected. Funds to support and encourage research on ARV adherence should be budgeted for and set aside, provision of adequate stocks of ARVs and co- treatment regimens should be facilitated and interventions targeting households with PLWHAs to ensure they have adequate supply of food should be developed.