Barriers to antiretroviral treatment adherence among HIV infected tuberculosis patients in Jaramogi Oginga Odinga Teaching and Referral Hospital Kisumu, Kenya
To achieve long-term viral suppression, near perfect ART adherence is required. Parallel administration of antiretroviral and antituberculous therapies among HIV and TB infected patients poses significant challenges, including cumulative drug toxicities, drug-drug interactions, high pill burden, and immune reconstitution inflammatory syndrome thus complicating treatment adherence among co-infected individuals. Socio-demographic, psycho-social, clinic setting and ART treatment factors have significant impacts on antiretroviral treatment adherence among HIV patients. However, there exists limited information on how the above factors contribute to ART non-adherence among patients from resource constrained settings. This study was conducted to examine barriers to antiretroviral treatment adherence among HIV infected TB patients in Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Kisumu, Kenya. The study addressed specific objectives which included: to determine how socio-demographic factors influence adherence to antiretroviral treatment, to establish influence of clinic setting factors on adherence to antiretroviral treatment, to examine influence of treatment factors on adherence to antiretroviral treatment and to assess how psycho-social factors influencing adherence to antiretroviral treatment among HIV infected TB patients in JOOTRH. The study adopted descriptive research design. Both quantitative and qualitative data were collected to gather comprehensive information on study variables. A standardized questionnaire was administered to 116 systematically sampled co-infected patients to generate quantitative data. An interview guide was used to facilitate in-depth interviews with 10 TB/HIV health care providers to generate qualitative data on structural barriers to ART adherence among co-infected patients. Descriptive statistics and content analyses approaches were used to analyze quantitative and qualitative data respectively, with the help of statistical software; SPSS v16.5 and Nvivo 8 in that order. The summary of study findings were presented in forms of tables, thematic extracts and discussions. The study measured adherence on the CASE scale and revealed that 49.1% of the respondents exhibited good adherence while 50.1% had poor adherence. Analysis showed that 29.3% and 21.6% of women and men exhibited poor adherence levels respectively. About 34.5% of the respondents aged 20-24 compared to 3.5% of those over 51 years exhibited poor adherence levels. The study also showed that clinical factors had negative impacts on ART adherence. Approximately 70.7% and 20.7% of the respondents reported that they have defaulted their as a result of poor drug supply and long waiting lines at clinic, out of which 42.2% and 3.4% exhibited poor adherence levels respectively. Majority of the respondents; 89.7% acknowledged the possibility of developing side effects as a result of treatment. However, 44.0% of them fell under poor adherence level regardless of being knowledgeable. Findings further showed that allergy and dietary restrictions had impacts on ART adherence since 44.7% and 43.1% of the interviewees who had experienced allergic reactions and dietary restrictions due to both medications fell under poor adherence levels in that order. Although an estimated 74.1% of the respondents had disclosed their HIV and TB statuses to their significant others, 44.8% of them fell under low adherence level. Estimated 81.9% of the patients felt stigmatized and felt embarrassed taking both TB and HIV medications in front of others. Out of 95.7% of the respondents remembered having received counseling services during their clinic visits, 49.1% and 46.6% exhibited good and poor adherence respectively hence indicating that counseling had an impact on adherence. Socio-demographic, clinic setting, ART treatment and psycho-social factors had significant impacts on ART adherence. There is need for comprehensive health education to promote treatment adherence among co-infected patients.