FACTORS ASSOCIATED WITH ADHERENCE TO READY TO USE THERAPEUTIC FOOD (RUTF) IN HIV POSITIVE ADULTS WITH ACUTE MALNUTRITION AT MBALE AND FORT PORTAL REGIONAL REFERRAL HOSPITALS IN UGANDA

Abstract

Introduction: Poor nutrition status in HIV positive individuals is a public health problem that could impact their survival. Although studies have established that RUTF is highly efficacious in management of malnutrition, there is a dearth of information on the prevalence of adherence to it and associated factors in the HIV population in sub-Saharan African countries. This study sought to describe the prevalence of poor adherence and related factors in HIV positive patients in Mbale and Fort Portal Regional Referral hospitals in Eastern and Western Uganda respectively. Methods: In a cross-sectional study, we enrolled 322 HIV positive malnourished patients from Mbale and Fort Portal Regional Referral Hospitals. Adherence to RUTF was measured using the Morisky 8-item Medication Adherence Scale (MMAS-8). Adherence was defined as poor if MMAS-8 was <8, and good adherence if MMAS-8 was 8. Logistic regression was used to estimate adjusted odds ratios (95% CI). IRB approval and informed consent were obtained. Results: The prevalence of poor adherence to RUTF was 52.8%. The contextual factors associated with poor adherence were: household food insecurity (AOR=4.64; 95% CI: 1.54-13.96); occasional stockouts of RUTF (AOR=2.86; 95% CI: 1.53-5.34), while the individual factors associated with poor adherence included depressive psychosocial symptoms (AOR= 6.22;95% CI: 1.81-21.35), dislike for the RUTF colour (AOR=5.23; 95% CI: 1.76 -15.53), and distance from home to the health facility of greater than 10km (AOR =3.72;95% CI:2.01-6.92). This study also revealed that the participants who had poor adherence did not have any unique foods or alternatives used when they missed using the RUTF. Conclusion and Recommendations: The study showed a high prevalence (52.8%) of poor adherence. The factors that were associated with poor adherence to RUTF were: household food insecurity, stock-out of RUTF, distance from home to the health facility of >10km, anxiety and depressive psychosocial disorders, and dislike for RUTF colour. This study, therefore, recommends patient screening to quickly identify patients with these risk factors for poor adherence as well as adapting a Differentiated Service Delivery (DSD) approach. Furthermore, the study recommends regular mentorship to ensure that services are streamlined, and client focused, and RUTF stock-outs minimized.