The Prevalence and Factors Associated with Non-Adherence to Antiretroviral Therapy among HIV+ People in Kampala.

Abstract

INTRODUCTION: About 40 million people around the world are living with HIV/AIDS with about 72% of these living in sub-Saharan Africa. The introduction of combination antiretroviral therapy (ART) for HIV infection revolutionized treatment of AIDS and HIV disease. It has been recognized that strict adherence to the combination, multidrug regimens is essential to obtain the full benefits of therapy, maintain suppression of viral replication and minimize the development of resistance. However, there are difficulties in establishing and sustaining exceptionally high adherence levels to these therapies over time. STUDY OBJECTIVES: To assess the prevalence of non-adherence to ART in HIV-infected patients in Kampala and beyond and to identify the associated factors in order to make recommendations to health care providers that will improve adherence to combination therapy. STUDY DESIGN: Cross-sectional study employing both quantitative and qualitative data collection methods. SETTING: The study was conducted at JCRJ, Nsambya hospital and mild-May international. These are specialized HIV/AIDS treatment centers. METHODOLOGY: A Total of 304 HIV infected persons on ART were enrolled into the study. The level of non-adherence was assessed by self-report using a semi-structured questionnaire. Two benchmarks were used to measure non-adherence: 5% and 20%. RESULTS: The prevalence of non-adherence the previous day, two, three, four and seven days before the interview was 29.4%, 31.6%, 32.4%, 32.7% and 37.3% (N=302) respectively at the 5% benchmark and 29.4%, 30.4%, 30.4%, 28.6% and 25.9% (N=304) respectively at the 20% benchmark. Factors associated with non-adherence at the 5% benchmark were forgetfulness (OR=5.86, 2.02-17.04), Monthly income 50,000 Ushs- 100,000 Ushs (OR=2.61, 1.31-5.22), 100,000 Ushs-500,000 Ushs (OR=3.20, 1.07-9.57) and self-efficacy belief (i.e confidence about one’s ability to maintain a behavior) (OR=0.41, 0.19-0.90). Factors associated with non adherence at the 20% benchmark were forgetfulness (OR=5.64, 1.45-21.96); Monthly income 50,000 Ushs 100,000 Ushs (OR=3.02, 1.42-6.04), Shortage of drugs due to lack of money (OR=0.4, 0.18-0.93) and inaccessibility of drugs (OR=7.56, 1.52-37.58). CONCLUSION: The prevalence of non-adherence in this population is 29.4% per day. About 1 in 3 people on ART are non-adherent in this population. The level of non-adherence in this population is worrisome given the fear of development of resistance so interventions should be made to minimize this level. Given the low earning power of most of the people, more affordable or free drugs should be provided for people who need ARVs.