Factors Associated With Level of Adherence to Antiretroviral Therapy in People Living with HIV/AIDS at Adama Hospital Medical College Art Clinic, Oromiya Regional State, Ethiopia

Abstract

Both Human Immunodeficiency Virus (HIV) infection and Acquired Immunodeficiency Syndrome (AIDS) remain major public health problems in Ethiopia. Good adherence to antiretroviral therapy is necessary to achieve the best virological response, lower the risk of treatment failure and drug resistance, and reduce morbidity and mortality. There are many alterable factors known to affect the treatment adherence. In this regard, there have been very limited researches particularly in Adama. Therefore, this study was aimed to determine the adherence level and its associated factors among adult people living with HIV and attending their clinical care in Adama Hospital Medical College. A hospital based cross sectional study was conducted from October 1, 2016 -January 30, 2017 G. C in Adama Hospital Medical College among 190 PLWHA on ART. Systematic sampling method was used to select study participants. Data was collected by interviewing the clients and review of their medical records using structured questionnaire and checklist. Data entry and analysis was performed using SPSS for windows version 20.0. Descriptive statics was used to summarize socio-demographic and other variables. Bivariate and multivariate analysis was used to evaluate the association between dependent and independent variables. Level of adherence in the week before interview was 92.6. Patients whose initial ART regimen was TDF-3TC-NVP, were 8 times (COR=8.444 (1.678, 42.501)), chance of <95% adherence than patients those started ART with TDF-3TC-EFV regimen. Patients with opportunistic infection were about 8 times (COR=7. 593 (2.196, 26.248)) chance of <95% adherence than their counter group respectively. Patients whose waiting time >30 minutes were 8 times (AOR=8.019 (1.161, 55.390)) chance of <95% adherence than their counter group. The level of adherence to ART was relatively higher when compared to others studies done in Ethiopia and other developing countries. But it was sub optimal to WHO adherence level (≥ 95%). The major reasons for missing doses were forgetfulness, away from home (travel) and lack of awareness. The level of adherence was significantly associated with variables like history of opportunistic infection, longer waiting time and starting treatment with TDF-3TC-NVP. This implicates further effort are still needed to push up the adherence to the level of WHO recommendation.

The effect of disclosure on adherence to antiretroviral therapy among adults living with HIV in Ethiopia: a systematic review and meta-analysis

“…The abstracts and full text of the remaining 25 studies were assessed and screened for eligibility criteria and whether they reported the outcome variable of interest (adherence); 18 articles were excluded due to failure to meet inclusion criteria. Two articles were excluded due to poor quality based on the selection criteria [17, 26]. Four articles were excluded because their regression tables did not include disclosure as an independent variable [27–30].…”

“…While the relationship between disclosure and adherence is fairly well-established in high-income settings, fewer studies have investigated the association in sub-Saharan Africa. Studies that have examined the association between ART adherence and disclosure among PLWHA in Ethiopia in particular have presented inconsistent results, with some finding strong positive associations and others finding limited or even negative associations between the two factors [17, 18]. The one existing systematic review of factors related to adherence in sub-Saharan Africa included only a handful of articles that examined the effect of disclosure specifically [6].…”

Adherence to Highly Active Antiretroviral Therapy and Its Association with Serostatus Disclosure among People Living with HIV in Ethiopia: A Systematic Review and Meta-Analysis.

“…The majority of the articles' adherent status to HAART was measured using self-report and taking ≥95% of the prescribed doses of medication is considered as good adherence to HAART (Table 1). Adherence to HAART Among 15 cross-sectional studies, the prevalence of adherence to HAART ranged from 65% (27,29) to 92.6% (25). The overall pooled prevalence of adherence to HAART is found to be 81.2% (80.1-82.3)( (Fig 2).…”

“…To determine the effects of serostatus disclosure on adherence to HAART among PLWHIV in Ethiopia, a total of four cross-sectional studies (23)(24)(25)(26) were used. This study revealed that clients who disclosed their serostatus to someone else are nearly three times more likely to adhere to their HAART compared to clients who did not disclose their serostatus(AOR= 2.99, 95%CI: 1.88, 4.77) (Fig 4).…”

Does Universal Test and Treat Strategy has an effect on Antiretroviral Therapy Adherence? A Comparative Cross-sectional Study

“…Evidence from a systematic review of adherence to ART in SSA also indicated that the average ART adherence score was 72.9% (5). In Ethiopia adherence to ART ranged from 63.8%-95.5% (6)(7)(8)(9)(10), most of them were below the WHO recommendation.…”