Determinants of adherence to cotrimoxazole preventive therapy among hiv infected persons on treatment in Machakos District Hospital, Machakos County, Kenya.
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Cotrimoxazole Preventive Therapy (CPT) also known as Sulfamethoxazole- Trimethoprim (SMX- TMP) is a broad-spectrum antibiotic that is active against both gram-positive and gram-negative microorganisms and protozoa. Further, it has been shown to reduce HIV related opportunistic infections and mortality risk by 25-46 percent as well as malaria, diarrhea, pneumonia and hospitalization rates. Yet, opportunistic infections continue to be among the leading causes of mortality and morbidity in HIVIAIDS. Almost half of the deaths from AIDS- related illnesses in 2010 occurred in Africa, with the pandemic claiming at least one million lives annually in sub-Saharan Africa. Despite the ready availability and low cost of cotrimoxazole preventive therapy and its documented benefits in reducing morbidity and mortality associated with HIV/AIDS, opportunistic infections continue to pose a major challenge in HIV/AIDS management, accounting for 47% of AIDS related deaths. Kenya is home to one of the world's harshest HIV and AIDS epidemics. An estimated 1.5 million people are living with HIV; with an estimated 1.2 million children orphaned by AIDS. In 2009 over 80,000 died from AIDS related illnesses. This research involved a descriptive cross-sectional survey with a broad objective of establishing the determinants of adherence to the uptake of cotrimoxazole preventive therapy among HIV infected persons in Machakos district hospital, Machakos County. Data collection was carried out using pre-tested interviewer administered semi-structured interview schedule and key informant interview schedules to randomly selected respondents. Two (2) focus group discussions were conducted with patients during their weekly support group meetings and their views on the factors influencing CPT uptake recorded. Five (5) key informant interviews were conducted with health workers from selected key departments within the facility. A total number of one hundred and seventy six questionnaires were administered. Quantitative data was analyzed using the Statistical Package for Social Scientists (SPSS) version 17 software. Hypothesis testing was done using chi-square test and significance established at p<0.05. Binary logistic regression was then used to identify the independent predictors adherence to CPT. Permission to carry out the research was sought from Kenyatta University Bioethical Committee and the Ministry of Education Science and Technology. Informed consent was sought from the respondents and confidentiality maintained. The study findings show a low level of knowledge on CPT (54.5%) among the respondents. The main determinants of adherence to CPT were substance use among the respondents (X2=31.818, df= 1, p<O.OO1), patients knowledge on CPT as a preventive therapy for OIs (P<O.OOl), and admission to hospital (X2=31.073, df=l, p<O.OOl). Other determinants of adherence to CPT were level of education (X2=33.238, df=l, p<O.OOl), religion (P<O.OOl) and facility support groups (P<O.OOl). The study recommends renewed community awareness on the importance of adherence to regimen among HIV/AIDS patients through social mobilization and education, as well as the development of a more robust defaulter- tracing mechanism for follow up. It further highlights the need to not only continuously screen and treat patients for substance abuse as part of routine HIV care, but also policy formulation that would enhance adherence to CPT and other related antibiotics.