| dc.description.abstract | Background: An estimated 37.7 million people are living with HIV globally with the majority being in sub-Saharan Africa. There is a need to address suboptimal adherence to prevent dolutegravir resistance in order to maintain its viral load suppression. The study aimed to find out the prevalence and factors influencing suboptimal adherence to dolutegravir-based regimens in adult patients who are in HIV care at Joint Clinical Research Centre Uganda.
Methods: We conducted a convergent parallel mixed methods approach, using a cross-sectional and an exploratory descriptive designs, in Joint Clinical Research Center Lubowa, between July and August 2022. A total of 366 HIV-positive adult patients who were taking dolutegravir-based regimens were enrolled. Quantitative data were collected using questionnaires, from consented, and consecutively sampled participants. Qualitative data were collected using in-depth interviews, among purposively sampled, consented, non-adhering patients, and key informant interviews among purposively sampled, consented health workers. Quantitative data was analyzed using modified Poisson regression to obtain factors associated with suboptimal adherence. Thematic analysis generated themes relating to suboptimal adherence, which were integrated narratively with quantitative data at the interpretation stage.
Results: The median age of participants was 44 years (IQR: 35-52), and 33.61% reported drinking alcohol. The prevalence of suboptimal adherence to dolutegravir-based regimens was 179/366 (48.9%; CI: 43.7-54.1). Alcohol consumption (aPR: 1.25; p-value: 0.039), employment level (aPR: 1.27; p value: 0.048), neighbour’s support (aPR: 0.78; p-value: 0.044), and health worker preferred (doctor) (aPR: 0.44; p-value: 0.025) were significantly associated with suboptimal adherence. The barriers and facilitators of adherence included; marital status, comorbidities, viral load, negligence, influence of churches, and herbal medicine use.
Conclusion: The prevalence of suboptimal adherence to dolutegravir was high. Strategies to address the problem are needed. High risk groups like alcohol consumers, the unemployed, those who lack family support should be targeted, especially during intensive adherence counselling. Patient-provider relationships should be strengthened, comorbidity management improved, and the public sensitized to improve adherence. | en_US |
