Determinants of adherence to anti-retroviral therapy and high risk behavior among HIV infected patients on treatment in Nairobi Province, Kenya.
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Date
2009-10
Authors
Oyore, J. P.
Journal Title
Journal ISSN
Volume Title
Publisher
Kenyatta University
Abstract
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 a lot of complacency during ART and feeling of reduced
infectivity by the patients on ART could lead to high risk sexual behaviour and enhance 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. This was a non -interventional cross-sectional study
using rapid appraisal techniques for collecting both qualitative and quantitative data. 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 among patients in selected treatment sites in Nairobi
Province, Kenya. A combination of data collection tools was used to gather the information in this study
including semi -structured questionnaires, adherence measurement tool and FGDs. 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 and Mann U Whitney tests (non -parametric 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 after which systematic
sampling was used to select the patients to be interviewed. 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 adherence with those having
more accurate knowledge more likely to adhere (X2 = 106.432 df = 7, p :s 0.001). The composite
adherence ART level of adherence from the three methods used among patients in Nairobi was found to
be 85% with 43% of the patients not achieving optimal adherence. The major factors that were found to
constrain adherence were costs (X2 = 306.02, df= 7, p:S0.001), lack of social support (X2 = 0.804, df= 7,
p~O.997), side effects (X2 = 92.583, df= 7, p:S 0.00), distance to the facility, gender (X2 = 104.006, df=
7, p:S0.02) , CD4 count at start of treatment. The results also indicated that a good proportion 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 or 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, it 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 assess their readiness to
initiate and adhere to ARV, identify gaps between knowledge and actual practice both for health
workers and PL WHA. The information will also be given to the PL WHA to enable them reduce the
high risk sexual behaviour that may predispose them to HIV re-infection. Itis recommended 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 on 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 the care providers
highlight the importance of adherence hence promoting adherence among the patients. There should
also be improved education targeting the PLWHA to sensitize them and remind them that they are not
free of HIV and AIDS v n af r b ing on tr atm nt and that th y would still t r -infected by other
strains of HIV.
Description
A thesis submitted in fulfilment of the requirements for the award of the degree of doctor of philosophy in public health in the school of health sciences of Kenyatta University. RA 643.75.O9