Influence Of Self-Reported Highly Active Anti Retroviral Therapy Side Effects On Adherence Among Persons With HIV Attending Tigoni District Hospital, Kenya.

Abstract

The introduction of highly active antiretroviral therapy (HAART) has led to a significant reduction in Acquired Immunodeficiency Syndrome (AIDS)-related morbidity and mortality. Adverse drug reactions are a commonly cited cause of poor adherence to HAART. The short-term adverse effects are potential threats to successful introduction and maintenance of HAART, while long term adverse effects can threaten sustenance of long term treatment. Although the association of side effects with adherence behavior seems intuitive, few studies have addressed this issue specifically. The objectives of this cross sectional descriptive study were to assess the level of adherence to HAART; variables predictive of sub-optimal adherence; medication side effects associated with HAART, and their association with adherence. Interviewer-administered questionnaires were used to assess adherence in the past 3 days (short term) and past one month (long term). The questionnaire also assessed the type and perceived intensity of 13 common HAART-related symptoms experienced during the last one month, and how these had affected the participant’s adherence to HAART. Data analysis was done using SPSS 17.0. Summaries were made for; HAART related side effects, regimen characteristics, patient factors and socio demographic characteristics. Short term (3 day) adherence and long term (1 month) adherence were categorized at the 95% level as adherent, (taking 95% or more of the prescribed drugs), or non-adherent (taking less than 95% of the prescribed drugs). Logistic regression was used to determine the factors significantly associated with adherence. Chi square tests were used to assess association between adherence and number and perceived intensity of side effects. A total of 183 patients were interviewed; 67.8% female and 32.2% male. The mean age was 39.2 years (±9.4) and 64.5% had been on treatment for over 13 months. Mean 3 day adherence was 96.4% (+/- 14.5) while mean 1 month adherence was 98.1% (+/-9.2). The most common reasons for missing medications were running out of drugs (11%) and being away from home (8.7%). During the preceding one month, 30.6% of patients had experienced at least one medication side effect. The most commonly reported side effects were; tiredness/general malaise (20.6%), rash (19.8), dizziness (17.5), nausea and vomiting (15.9%), stomach upsets (15.9%), sleepiness (15.9%) and headache 20(15.9%). Only 14.2% of patients who experienced side effects reported that they influenced their medication taking in some way. Among these, only 5.4% stopped taking their medications as a result. Side effects were neither associated with short term adherence (OR 1.98 P-value 0.13); nor long term adherence (OR 1.01 P-value 0.97). The last time a patient missed medication predicted long term adherence (OR, 1.7; P=0.03). Other patient factors and regimen characteristics were not found to predict adherence to HAART. The duration a patient had been on treatment was significantly associated with the number of side effects (Chi-square p-value 0.04); patients who had been on treatment for longer had more side effects than those who had been on treatment for a shorter period. These results show that HAART patients in Tigoni had optimal of over 95%. Those who had a gap in taking medication during the preceding 2 weeks were more likely to be non-adherent. General Malaise, Rash, Dizziness, Nausea and Vomiting, Stomach Upsets, Sleepiness and Headache were side effects that were commonly experienced in this setting. However, side effects did not significantly affect adherence.