Factors associated with adherence to antiretroviral and cancer chemotherapy among patients with HIV–Cancer comorbidity attending Uganda Cancer Institute

Abstract

Introduction and background Human ImmunodeficiencyVirus (HIV) is a major global public health issue affecting millions of people worldwide but continues to vary between countries and regions, Sub-Saharan Africa where Uganda is inclusive carrying a disproportionate burden. A great number of people with HIV are developing cancer co-morbidity and that has increased mortality among HIV-infected patients. This has led to the use of co-medications that may affect ART and cancer chemotherapy adherence. Objective: To determine ART and anti-cancer chemotherapy adherence and associated factors among cancer patients infected with HIV attending Uganda cancer institute. Methodology: A cross-sectional study was conducted among 200 adult cancer patients infected with HIV, attending Uganda cancer institute. Antiretroviral and anti-cancer chemotherapy adherence with associated factors were assessed using a mixed methods strategy where both qualitative and quantitative methods were used. Data was collected using interviewer administered semi-structured questionnaires and 7 in-depth interviews were conducted. Qualitative data was analyzed using thematic content approach and for quantitative data, Modified Poisson regression with robust standard errors were used to estimate prevalence ratios at 95% confidence intervals for factors associated with adherence. Results: There were 200 respondents, the majority were male 122(61%), Anglican (43%), married (56.5%), in informal employment (40%), had attained at least a primary education (45%) were aged between 36 and 45 years (37%). Mean age was 42 years(SD± 11 years). Patients with good adherence to antiretroviral therapy and chemotherapy were 107(54%, 95% CI=46.5-60.4). No knowledge of cancer stage (PR=0.4, 95% CI=0.25-0.56, P<0.0001), having an AIDS defining cancer (PR=0.7, 95% CI=0.50-0.88, P=0.005), ART clinic in district not near Uganda Cancer Institute (PR=0.7,95% CI=0.84-0.96, P=0.027) and affordability of cancer chemotherapy (PR=1.4, 95% CI=1.02-1.87, P=0.037) were associated with adherence to both ART and cancer chemotherapy. Conclusions Overall, adherence to both ART and cancer chemotherapy was low. The following factors were found to be associated with this adherence, these include knowledge of the cancer stage by the patient, the type of cancer diagnosis , source of antieretroviral therapy and affordability/ availability of medications. Recommendation: Information on stage of cancer and adherence couselling should be provided to patients. Integration of HIV- cancer care services is required and medications should be supplied at a free or affordable costs.