Factors influencing patient adherence to antiretroviral treatment at Mbagathi district hospital, Nairobi, Kenya
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Date
2011-08-16
Authors
Osoro, Ednar
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Abstract
Antiretroviral therapy was introduced in the mid 1990's as a way of managing HIV (Human Immunodeficiency virus) disease. Nevertheless, the clinical management of HIV disease continues to present major challenges. One of the foremost concerns of antiretroviral programs is the ability of people living with HIV and AIDS (PLWHA) to maintain near perfect adherence over the long term. In order to achieve the goal of antiretroviral therapy (ART), undetectable levels of the virus in the blood, patients are required to maintain more than 90-95% adherence. Both patients and health-care providers face significant challenges with respect to adherence to ART. The rapid expansion of ART programs currently underway in sub-Saharan Africa, underlies the relevance of adherence for ensuring optimal treatment outcomes. The challenges posed by patient adherence are a great concern in the widespread provision of ARVs in high, low and middle income countries. The ability of health care systems to ensure patient compliance to complex antiretroviral regimens is unknown to many. In Kenya, price reductions have made this treatment more affordable to many patients and this has raised questions of the follow-up and adherence among people on medication. The significance of adherence cannot be underestimated because of the possibility of the development of resistance to treatment. Hence, this cross-sectional study sought to assess adherence challenges and examine opportunities of provision of ARVs at Mbagathi District Hospital, Nairobi. The hospital facility was conveniently chosen for its large catchment area, presence of a well-established ART program as well as the availability of clients who meet the inclusion criteria of the study. The study assumed four phases, which involved data collection by means of an English and Swahili translated self-administered questionnaire, three focus group discussions with a male only, female only and mixed groups; three face to face in-depth interviews with one nutritionist, an adherence counselor and a nurse/administrator and desk reviews of the source material respectively. The tools used in data collection included a self-administered questionnaire, an FGD and interview structured questions. The parameters investigated included: socio-economic and demographic factors (Age, Gender, religion, level of income, knowledge levels, stigma, marital status, period of treatment, family size) behavioral factors (condom use, health seeking behavior, clinic attendance), use of complimentary medicines and alternative therapies and perceptions on treatment and patient participation. The data obtained was verified by the software package Epi-info (version 6.0) and analyzed using the chi square test of significance of the variables on adherence in the statistical package for social sciences (SPSS) version 11.0. Results indicated that of 208 respondents included in the study, 120 (60.6%) fully adhered to ARV therapy. The chi-square test of significance showed p < .05 for three main adherence factors, religion (P = .0037), period of treatment (p = .002) and patterns in condom use (p = .006). Knowledge levels, level of income and aspects of stigma were shown to be strong predictors of adherence. The findings indicated that cross cutting cultural themes influence adherence behavior. These findings will be instrumental to all stakeholders in scaling up institutional responses to the management of HIV and AIDS. Hence, this will facilitate closing the gap between the potential benefit that ART has to offer and the reality that for many people these drugs are unavailable, unaffordable, unsafe and improperly used
Description
Department of Zoological Sciences, 97p. The RC 607.7. O8 2009
Keywords
Antiretroviral agents, Kenya, AIDS (dieases), HIV infections