Factors Affecting Adherence to Antiretroviral Therapy in Siaya County, Western Kenya

Abstract

This was a cross-sectional descriptive study that set out to explore the factors affecting adherence to antiretroviral therapy (ART) by people living with HIV and AIDS (PLWHA) in Siaya County. The study examined the various costs associated with adherence to ART including costs of treatment of opportunistic infections, transport to health facilities and nutrition. The study also examined how stigma, cultural and religious beliefs and social support affected PLWHA‟s adherence to ART. The study population consisted of PLWHA who were aged 18 years and above and were enrolled in ART. The study was guided by the behavioural model of health services use and Sweat and Denison‟s model of HIV and AIDS structural factors. The research was conducted from June, 2014 to December, 2015. Qualitative methods of data collection, including in-depth interviews, focus group discussions, case narratives, key informant interviews and direct observation, were used. The sample population comprised 210 PLWHA. Data were analysed using the ATLAS-ti computer software. The findings reveal that poverty, stigma, cultural and religious beliefs and lack of social support hampered PLWHA‟s adherence to ART in Siaya County. The findings indicate that the majority of PLWHA did not afford the costs of medication for opportunistic infections, transport to health facilities and nutritious diet, all of which are important for successful adherence to ART. The study also established that adherence levels to ART for PLWHA who received social support from healthcare workers, family members, communities, friends, treatment partners, and other support groups was higher compared to those who did not receive any. The study concludes that the costs associated with adherence to ART including the cost of treating opportunistic infections, transport to health facilities and nutrition hindered PLWHA‟s adherence to ART. In addition, stigma, cultural and religious beliefs and lack of social support also affected PLWHA‟s adherence to ART negatively. The study also concludes that availability of social support promoted adherence to ART. Despite the potential for ART to bring positive health outcomes, the study found that non-adherence to treatment had negative socio-economic impacts on PLWHA in Siaya County. Non-adherence implies that PLWHA are as of yet, to enjoy the full benefits of free ARV drugs provided by the government of Kenya. Findings from this study provide deep insights into how poverty, stigma, religious and cultural beliefs and lack of social support have undermined the government‟s effort to curb the spread and negative health impacts of HIV in Siaya County. The study recommends that prudent strategies be put in place to address the problem of HIV and AIDs related stigma and that PLWHA be sensitized on negative cultural and religious beliefs which are detrimental to their health and the health of the other members of the community in general. The study also recommends an establishment of an online data base for all PLWHA enrolled in ART in all health facilities in the Country to curb against PLWHA who move from one health facility to another after defaulting in treatment and also to account for each and every PLWHA who is enrolled in ART in terms of adherence and treatment progress. Finally, the PLWHA should be economically empowered through the creation of employment and business opportunities as well as safety net programmes to enable them deal with treatment-related costs including medical insurance.