Factors Associated Wlth Optimal Art Adherence And Better Clinical Outcomes In Patients Enrolled At Casino Hiv Clinic Nairobi
Machera, T M
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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.