Effects of psychosocial support on anti-retroviral therapy adherence and clinical outcomes of hiv patients at Kwale and Machakos, Kenya
Machera, Tom Marwa
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The effects of psychosocial support on ART adherence and clinical outcomes following an HIV diagnosis have been well documented in western countries where linkages between HIV-related treatment and psychosocial support programs are well established, little is known about those who become engaged with such services in countries of the world where comprehensive HIV-related care and prevention systems are continuing to develop. The aim of the study was to understand how patients’ psychosocial factors might affect antiretroviral treatment adherence and other clinical outcomes and to identify key components of support, including the social and economic aspects necessary for promoting optimal adherence. The objective of this study was to investigate the effects of psychosocial support on ART adherence and clinical outcomes of HIV patients enrolled at Kwale and Machakos district hospitals. This was a cross sectional study which was carried out at Machakos and Kwale HIV Comprehensive Care Clinics (CCC).Two different types of structured questionnaires were administered; one on the HIV positive clients/patients enrolled on care at the CCC and their past six months and over records reviewed by looking at the CCC patient blue card (abstraction). Data was collected using pre-tested questionnaire which were administered to each of the 440 clients/patients selected randomly from a population of 2820 clients/patients on care at the CCC. Individual in-depth interviews and focus group discussions were conducted with CCC managers and support group leaders to collect qualitative data. SPSS was used to conduct data analysis, descriptive statistics to examine the frequency. The study findings showed that patients linked to HIV support groups were able to adhere to ART optimally (Chi-square=20.7, p=0.000 and 93.8, p=0.000 in Kwale and Machakos respectively) and had better clinical outcomes compared to those who were not, among the clinical outcomes that the study investigated were opportunistic infection relapses and new OIs (t=-2.928, p= 0.004), weight outcomes (t=2.170, p-value=0.031) and failing of the first line ARVs regimen (Chi-square 8.74, p=0.003 and Chi- square 40.15, p=0.000 respectively). The study data indicated that there were no statistically significant relationships between occupation and adherence level including clinical outcomes of the linked and non linked patients. The study used t-test and Chi-square tests to establish if there was a difference in clinical outcomes such as opportunistic infections, gain in body weight and ART adherence between the linked and non linked patients. Linked patients had better clinical outcomes and optimum ART adherence compared to non linked patients. There is need to encourage formation of HIV psychosocial support groups at the community level, these support groups should be linked to health facilities’ HIV comprehensive care clinics to complement the continuum of care between facilities and the community. The Ministry of Health and other stakeholders should encourage formation of HIV psychosocial support groups, including addressing their sustainability and further support through income generating activities.