Predictors of adherence to Highly Active Antiretroviral Therapy (HAART) among HIV patients attending Comprehensive Care Centres (CCC) in selected Hospitals in Kericho County

Abstract

Adherence is a complex and dynamic process. Just like other chronic diseases, HIV presents significance challenges in achieving and maintaining adherence. HAART is undoubtedly the only proven remedy known to improve the health outcomes and reduce AIDS-related mortality. However, the effectiveness of HAART solely depends on adherence. An optimal adherence levels of >95% is required so as to achieve viral suppression. Data from different studies indicate that few, if any, patients have achieved optimal adherence. Adherence to HAART is still unsatisfactory and it ranges between 27 and 80% across diverse populations and sub-populations in different studies, as compared with the stipulated optimal adherence level of 95%. The overall objective of this study was to determine the predictors of adherence to Highly Active Antiretroviral Therapy among HIV patients attending comprehensive care centres in selected hospitals in Kericho County. The study adopted a descriptive cross-sectional. It involved 261 HIV patients (≥ 15 years) on HAART attending Comprehensive Care Centres in the selected hospitals. The three hospitals were purposively selected. Data was collected from the patient’s using interviewer administered questionnaires while Key informant interviews were held with healthcare providers involved in HIV care at the selected hospitals. Viral load was used as a measure of adherence. This was done by looking retrospectively into the patient file. Individuals who achieved viral suppression (<50 HIV-1 RNA copies/ml) within 3-6 months of HAART initiation were considered to have optimal adherence while individuals who had viral load of between 50-1000 HIV-1 RNA copies/ml after 3-6 months of HAART initiation were considered to have sub-optimal adherence. Attitudes towards HAART were measured using the Likert scale. Data was analyzed using SPPS version 25. A chi square test was used as an initial screening tool for any association between dependent and independent variables. Logistic regression analysis was used to determine the association between adherence to HAART and various independent variables with significance level of p<0.05 set for all statistics. Findings from this study indicate that the level of adherence to HAART in Kericho county is 76%. Having a tool/someone to remind of when to take HIV medication, (P=0.034) and food security, P=0.042) were found to be promoters of optimal adherence. On contrary, Age category (20-24 years) (P=0.02) and use of HAART alternatives (P=0.01) were found to be risk factors of sub-optimal adherence high sub-optimal adherence levels. From the Key informant interviews, young adulthood (18-28years) was found to be a risk factor for sub-optimal adherence. This study recommends routine adherence monitoring for patients in the age category 18-28. Additionally, this study recommends more research into aspects of attitude and practices towards HAART.