Detection and management of adverse drug reactions related to Antiretrovirals among HIV/AIDS patients in Kiambu District, Kenya
Nderitu, Florence Wambui
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Acquired Immune Deficiency Syndrome (AIDS) is one of the most significant infections to appear in the recent times. Worldwide it is estimated that 33.4 million people are living with the syndrome 68% of whom are in Sub-Saharan Africa. There are 4 million people worldwide on treatment although another 5 million eligible for treatment do not have access to life prolonging treatment and care. Antiretroviral drugs are used to prolong and improve the quality of life for those infected. This therapy is associated with side effects and adverse drug reactions (ADRs) of varying degrees in frequency and severity. A better understanding of adverse effects is of interest not only to the HIV specialists as they try to optimize on therapy but also to the patient who may not be aware of these adverse reactions due to the multiple symptoms associated with the AIDS syndrome. Not much is known about ADRs in Kenya because most knowledge is from the West where research and capacity to react comprehensively to research in clinical challenges posed by the syndrome is sufficient. The objective of this study was to establish the prevalence, detection and management of various ADRs occurring in patients attending Comprehensive Care Centre of Kiambu District Hospital. The study was a cross sectional survey where patients included were those attending the Comprehensive Care Centre on a monthly basis. The patients were selected by convenierice sampling depending on their ability and willingness to participate in the study. Data was collected from 354 respondents using an investigator- administered questionnaire. Analysis was done using SPSS version 11.50 software. Chi-square test was used to test significance and logistic regression carried out to determine the independent effect of selected variables on occurrence of ADRs. Statistical tests were performed at 5% (P=0.05) level of significance. The results revealed that 65.2% of the patients had experienced symptoms suggestive of ADRs. Of these, 67.2% did not associate the symptoms to the medicines they were taking but rather to the disease. The most prominent ADR was peripheral neuropathy at 0.395 (95% CI 0.344,0.447) while the least common was hepatotoxicity. Whereas 71.5% could tell the frequency of the daily dosage, 92.1 % did not know the names of the medicines they were taking but could describe them by shape and colour. There was a significant association between occurrence and reporting of ADRs and age (P<O.OOI), weight (P=()I.OOl), marital status (P=0.016), occupation (P<O.OOI), religious participation (P<O.OOI), education level (P<O.OOI). Although the health care providers displayed adequate knowledge in management of ADRs, they complained of inadequacy of the current reporting tool (MOH 257) in capturing ADRs. The patients were ill equipped in detecting the ADRs. This study suggested an ADR reporting tool which the patient could use at home and notes the ADRs symptoms on a daily basis as they occurred. The study also recommended that more health information should be given to patients to enable them detect and report ADRs early enough for proper management.