Factors Influencing Adherence To Antiretroviral Therapy In Embu Teaching And Referral Hospital, Embu County, Kenya

ABSTRACT

Adherence to antiretroviral therapy is a major predictor of the survival of individuals living with HIV/AIDS. Appropriate use of antiretrovirals (ARV’s) has improved the health of many human immunodeficiency virus (HIV) positive individuals. The effectiveness of HIV treatment depends on sustenance of high levels of adherence to ARV; however, ARV regimens are often complicated and can be affected by varying dosing schedules, failing to have proper dietary requirements and patients developing adverse effects. The main objective of this study was to determine factors influencing adherence to Anti-retroviral drugs among HIV and AIDS patients 18 years and above in Embu Teaching and Referral Hospital comprehensive care clinic. A cross sectional study was carried out at EmbuTeaching and Referral Hospital in EmbuCounty, Kenya. Stratified random sampling was used to obtain relative proportion of male and female adult respondents in the sample population. Three hundred and thirty one HIV positive patients were chosen from a total of 1694 patients who were active in ART for more than one year. A semi-structured interview schedules was used to obtain demographic information and patients view on various dimension or ART services at the facility. The study revealed thatalmost half (48.2%) of the respondents had optimal adherence to ART treatment while 51.8% had sub-optimal adherence to ART treatment. Over a third (34.9%) of the patients indicated that travelling was the main cause of hindrance to optimal adherence to treatment. Other reasons included forgetfulness 23.5%, tiredness of taking drugs all the time 20.8% and side effects 20.8%. Patients aged below 25 years were more likely to have optimal ART adherence as compared to respondents aged 56 years and above (ᵡ2=10.745, df=4, p-value = .030). Monogamously married and polygamous married patients more likely to have optimal adherence as compared to widowed or widower respondents (ᵡ2=17.944, df=4, p-value = .001). Majority (88.0%) of the respondents had disclosed their HIV status to other people of whom 46.9% had disclosed to their spouse/sexual partner and 49.7% of them had been accorded moral support. There was significant association between adherence to ART and the type of drug respondent was using with AZT, ddl, NFV having the highest proportion of sub-optimal adherence to treatment while respondents on D4T, 3TC, NVP had the lowest proportion of sub-optimal adherence to treatment. Patients who had sub-optimal ART adherence significantly had longer waiting time and deemed costs of co-infection treatment to be higher as compared to respondents who had optimal ART adherence. Convenience of the facilities for people with chronic ailments and waiting time at the facilities were reported to be lower. The study concludes that majoritypatients had sub-optimal adherence to ART treatment. Adherence was significantly influenced by age; marital status; engagement in income generating activity;type of drug takenand costof co-infection treatment;health facility accessibility and perceived waiting time.The study recommends that HIV patients should be sensitized on importance of carrying ART drugs when travelling and the use of treatment assistants to ensure optimal adherence thus enabling them fully realize its life extending benefits as it has been shown that there is significant non-adherence among HIV positive patients on ART in the County.