dc.description.abstract | Background: HIV/AIDS has been a rapidly growing public health problem in Kenya. The current
HIV prevalence in Kenya stands at 5.6%, the prevalence among women in the country is 6.9%,
compared with 4.4% among men (KAIS 2012). The resultant morbidity and mortality rate has
negatively impacted every sector of society. Non adherence to ART treatment is an important
public health problem and one that involves substantial morbidity and medical costs. Poor ART
drug adherence eventually leads to poor clinical outcomes and death in many HIV patients in
Africa. Adherence to the regimen is essential for successful treatment and sustained viral control.
Adherence to ART is a major predictor of the success ofHIV/AIDS treatment.
Objectives: The study was conducted to establish factors associated with optimal ART adherence,
levels of adherence in the patients and determine clinical outcomes in these patients enrolled at
Casino HIV clinic.
Study design: This was a facility based cross sectional study
Setting: The study was conducted at Casino City Council HIV comprehensive care clinic (CCC)
located within Nairobi central business district area and has over 2220 patients enrolled into HIV
care and treatment.
Methodology: Structured questionnaires were administered on the 185 randomly selected HIV
positive patients. In this study, patients were interviewed about their adherence over the previous
week and previous month successively in an attempt to minimize recall bias. In both the tablet
counting and self-reporting methods, adherence was defined as taking 95% of prescribed doses over
the previous month which correspond to missing no more than one dose in a l O-day period. Patients
were classified as non-adherent if they missed more than 5% of their doses.
Data Collection: Information collected included demographic information, period on ART, history
of opportunistic infections, body weight history and CD4 levels; this provided clinical outcome
information of the study participants. Individual in-depth interviews and focus group discussion
were conducted to collect qualitative data to establish other factors that contributed to optimal ART
adherence.
Main outcome measures: The main clinical outcome measures in this study were participants'
weight gain/loss, CD4 levels and episode of opportunistic infections; adherence levels was
determined by how many times the patient had defaulted taking ARV drugs in the last one month.
Data Analysis: Data was collected coded using the standard coding system. SPSS 17.0 version
was used to conduct data processing and analysis. Descriptive statistics, correlation and univariate
analysis between variables were conducted to provide main study outcomes. Qualitative data was
analyzed by categorizing responses into four different responses which were further coded for
analysis.
Results: The study findings showed that there was over 90% adherence rate among the respondents
across all time instances. 59% (92) of the respondents faced a myriad of challenges when initiated
on ART, however only 18% (17) had below 90% adherence level. The study identified factors such
as health workers attitude, multiple ARV regimen, educational level, gender and income levels (pvalue
<0.005)to have no statistically significant effects on optimal adherence, however psychosocial
intervention factors such as support from friends and family members had an effect on ART
adherence compared to those who did not receive these support (Chi-square=20.7, p=O.OOOand
93.8, p=O.OOOrespectively) and had better clinical outcomes. The study findings showed that
between 6 and 36 months after initiation of ART; there was a significant reduction in opportunistic
infections (67%) and an overall increase in weights; with a mean increase of 4.1 kg ( p-value=
0.005). The study data showed that 62% of the respondents commenced ART medication at WHO
stage two, however 93% (107) of the respondents in this stage had> 90% adherence rate. | en_US |
dc.description.department | a
Department of Psychiatry, University of Nairobi, ; bDepartment of Mental Health, School of Medicine,
Moi University, Eldoret, Kenya | |