Factors that Influence Treatment Adherence among Male Sex Workers on Antiretroviral Therapy in Nairobi City County, Kenya

Abstract

Adherence to antiretroviral medications is important in transforming and expanding treatment programmes for both individual and public health benefit. The medications are known to reduce the risk of transmission of HIV and reduce AIDS related mortality if adhered to. This study set out to determine factors that influence treatment adherence, based on self-reporting assessment among male sex workers on Antiretroviral Therapy in Nairobi City County, Kenya. Using a cross-sectional study design, quantitative and qualitative research methods, 260 male sex workers receiving antiretroviral therapy, were selected through respondents driven sampling and interviewed using a semi- structured questionnaire. Three focused group discussions with 37 male sex workers and 12 key informant interviews (3 clinicians, 3 pharmacist, 3 counsellors and 3 treatment site managers) were conducted. The quantitative date was analyzed using Statistical Product and Service Solutions (SPSS) version 12 and thematic analysis done for qualitative data. Univariate, bivariate, and multivariable analyses assed the proportion of adherence and correlates of self- reported adherence. Chi-square test and Fisher’s exact test was done and P-values set at < 0.05 was considered statistically significant. Odds ratios were used to show the strength of association. Factor analysis was done to extract most important barriers of adherence. The proportion of male sex workers who self-reported adherence was established at 40% (104) as compared to non-adherence of 60% (158). Factors that influenced self-reported adherence among the male sex workers were Antiretroviral therapy associated cost ART (χ2 = 10.767, d.f=1, p=0.001;) knowledge on HIV and ART (Fishers Exact Test p=0.045) alcohol and drug abuse Fisher Exact Test (p<0.001); perceived poor treatment by ART health provider (χ2 = 4.9364; d.f=1; p=0.026) and ever had a clinical monitoring test of CD4 count (χ2 =11.143;d.f=1;p=0.001) and main reason for getting into sex work (χ2 =5.715, d.f=1 p=0.017) and perceived barriers of ART (p<0.00) Fisher Exact Test). Those who score highest on knowledge of HIV and ART were more likely (OR 2.1; 95% CI; 1.1-3.8) compared to those who scored the least. Those who reported clinical monitoring through CD4 count were more likely (OR 3.4; 95% CI; 1.6-7.2) while those who abused alcohol and drugs and perceived they are poorly treated by the xvii ART provider were unlikely to adhere. Experience of side effects, lack of support or care, sharing of pills and lack of time to attend clinics (p<0.001Fisher’s Exact Test) were identified as the key barriers correlated to self-reported non-adherence. The use of multidimensional male sex workers centered treatment model that addresses structural barriers such as cost related to antiretroviral access, sensitizing of health care workers against homophobic tendencies and integrated with interventions to address alcohol and drug abuse and is recommended.