Determinants of adherence to Anti-Retroviral therapy and high risk behaviour among HIV infected patients on treatment in Nairobi province, Kenya
Anti-retroviral therapy (ART) has been successful in dramatically decreasing the morbidity and mortality caused by HIV infection. Levels of adherence in excess of 95°/, are required to ensure treatment success, adequate viral load suppression, improved immune status and slowing of the disease progression. It has also been reported that and feeling of reduced infectivity by the patients on ART could lead tonhance transmission of HIV. To date there is very little scientific data on ART adherence, factors influencing it and any resultant high risk behaviour in Nairobi, Kenya. cross-sectional study using rapid appraisal techniques for collecting both qualitative and quantitative cl.ita. The main objective of this study was to determine the levels of adherence, factors influencing it and identify any resultant high-risk behavioural changes during ART treatment sites in Nairobi Province, Kenya. A combination of data collection tormation in this study including semi -structured questionnaires, adherence measurement tool and FGD,. Qualitative data was consolidated using data matrices. Analysis of qualitative data was done by triangulation based on major themes or constructs. Quantitative data was analyzed using the statistical package for social scientists (SPSS) version 16.0. Hypothesis testing was done using Chi-square and Kruskal-Wallis tests to test the significance of the categorical variables. T-tests arametric tests) were used to assess the differences between groups for continuous variables. Multistage sampling design was used since convenience sampling was used to determine the health facilities alter which systematic sampling was used to select The results indicated that just about half ,216 (48%) of the PLWHA had accurate knowledge of what ARVs were and what they do to the body. There was a significant relationship between knowledge of ARVs and adhere (x2 imal adherence. The major fact((x2 rt= 0.804, df = 7, p<_0.997), side effects = 92.583, df = 7, p <_ 0.00), distance to the facility, gender 104.006, df =7, p<0.02) , CD4 count at start of treatment. The resproportion 342 (76%) of the patients who had been on treatment for over six months had engaged in high risk HIV transmission behaviour by either. having sexual intercourse without protection with partners of unknown HIV status. Quality of care is affected by lack of adequate supply of drugs and training of health workers. These findings will help policy intervention towards improving access and adherence to ARV through carefully planned and evaluated interventions. Furthermore, ii will lead to the improvement of the quality of medication discussions and care so that both patients and care providers receive and understand the information they need, enable patients to accurately as their readiness to initiate and adhere to ARV, identify gaps between knowledge and actual practice both for health workers and PLWHA. The information will althem reduce the high risk sexual behavior that may predispose them tded that there should be more education and information provided to the patients prior to initiating ART so that they know the facts about ARVs. In conclusion, the study found that majority of patients )n ART does not achieve optimum adherence levels and that 342 (76%) of patients on ARVs are engaging in risky sexual behaviour. The study also recommends more targeted counseling be provided by fie care providers highlight the importance of adherence hence promote. There should also be improved education targeting the PLWHA to sensitize them and remind then that they are not free of HIV and AIDS even after being on treatment and that they would still get re-infected by other Strains of HIV.