Factors affecting adherence to cotrimoxazole prophylaxis among HIV/AIDS patients in Rukungiri District, Uganda.

Abstract

INTRODUCTION: Globally, 33 million people are estimated to be living with HIV of which 22 million are in sub Saharan Africa. In Rukungiri district, 20115 people were estimated to be living with HIV/AIDS. With adherence to cotrimoxazole prophylaxiz, all these people can benefit from considerable reductions in morbidity and mortality due to opportunistic infections. AIDS account for 17.5% of the discounted life years lost, after malaria in the district.The district notes that treatment of opportunistic infections in HIV/AIDS patients is expensive and this poses a big challenge to the district resources. OBJECTIVES OF THE STUDY: This study aimed at establishing factors that influence adherence to cotrimoxazole prophylaxis among HIV positive adult individuals in Rukungiri district in order to generate information that will be utilised by the DHT to enhance cotrimoxazole prophylaxis. This was achieved through identification of patient related factors, drug related factors and health service delivery factors that affect adherence to cotrimoxazole prophylaxis. METHODOLOGY: This was a descriptive cross-sectional study at Kisiizi and Nyakibale hospital in Rukungiri district. Data was collected using both qualitative and quantitative techniques. A total of 283 clients started on cotrimoxazole prophylaxis at least for two months were interviewed using a pre-tested semi-structured questionnaire. Two measures of adherence were used, that is self report and visual analogue scale, qualitative data was collected from six focus group discussions using guides. Quantitative data was entered using EPI INFO 2002 and then exported to SPSS software for analysis. Quantitative data was analysed manually using a master sheet analysis and presented in text form. RESULTS: From self reports, adherence was 65.7% measured in the previous five days, while on a 30 day visual analogue scale, adherence level was 17.7%. Independent predictors of adherence were age (p value of 0.095), marital status (p value of 0.000), whether any family member knew about the patient’s HIV status (0.001), Distance from the healthy facility (p value of 0.042), patients waiting for long hours (p value of 0.028), whether other members in the family were taking cotrimoxazole prophylaxis (p value of 0.008) and duration CONCLUSION: Levels of adherence by self report were fairly acceptable. However, on a visual analogue scale, levels of adherence were poor. Determinants of adherence in the district include age, marital status, family members knowing about a patient’s HIV status. Distance from health facility, other family members being on cotrimoxazole prophylaxis and duration on the prophylactic programme. RECOMMENDATIONS: Rukungiri district health office needs to carry out extensive HIV counselling (and testing) and also increase on the numbers of health workers at the treatment centres.