Adherence to antiretroviral therapy among patients in a rural setting in Kenya

Abstract

Although the need to develop effective antiretroviral regimens has largely been met, the need to find a way to promote the near perfect adherence required for optimal outcomes is a challenge that has yet to be surmounted .. This study was intended to help KDH and the ART clinic formulate strategies that can be employed to improve current and future ART programs so as to optimize overall therapeutic goals. The protocol objective was to conduct a crosssectional survey by interviewing patients receiving antiretroviral therapy (ART) at the Kericho District Hospital (KDH) , Kenya in order to understand ART adherence levels, factors that hinder or promote adherence to ART and the role of demographic and psychosocial factors in adherence.A total of 398 volunteers were interviewed. This was a study in which all patients who met the inclusion criteria were included. Both qualitative and quantitative methods were used. Patients receiving ART at KDH were sampled consecutivelyfor questionnaire interviews while purposive sampling was used in the selection of the FGDs participants at the Matobo Live with Hope HIV/AIDS support group. The study used a triangulation of data collection methods. Interviewer administered questionnaires were used to collect quantitative data, while focus group discussions and key informant interviews were employed to collect qualitative data. SPSSIPC programme was used to enter and analyze data. The study found that the mean adherence level for the participants was 98.8%. Majority of the participants 381 (95.7%) reported being 100% adherent to therapy. There was a statistically significant relationship between adherence and knowledge (P<0.013), adherence and level of education (P< 0.005), adherence and income (P< 0.035), adherence and attitude to ART (P< 0.028) and adherence and stigma (P< 0.044). There was statistically no association between adherence and age, sex, marital status, family size counseling and disclosure. The most important barriers to ART adherence included: side effects of antiretroviral drugs, long distance to the clinic with financial consequences, long waiting time at the clinic and stigma. Patientsperceived that a good understanding of the importance to adhere to medication, timely refilling of prescriptions, use of organizational aids, social support from family members,

support groups and health care workers and belief in drug efficacy to be key in facilitating ART adherence. The levels of self reported adherence in patients receiving antiretroviral therapy at the Kericho district hospital are comparable to those in resource rich settings. It is possible for patients in poor countries to achieve near perfect levels of adherence with elimination of costs related to ART coupled with thorough counseling and patient support. In addition to counseling, interventions to promote adherence such as reminders, tailoring the regimen to the patients life style and addressing issues related to side effects may improve adherence. There is an urgent need to set up national programmes focused on HIV stigma reduction and patient education on HN and adherence to treatment in order to achieve near perfect adherence levels.