Factors influencing HAART adherence among private health care sector patients in a suburb of the Ethekwini Metro

Abstract

BackgroundThe advent of highly active antiretroviral therapy (HAART) ushered in a new era in the management of the AIDS pandemic with new drugs, new strategies, new vigour from treating clinicians and enthusiasm on the part of their patients. What soon became evident, however, was the vital importance of patient adherence to prescribed medication in order to obtain full therapeutic benefits. Several factors can influence adherence to HIV drug regimens. Many treatment regimes are complex, requiring patients to take a number of drugs at set times during the day, some on a full stomach and others on an empty one. Other factors that could contribute to non-adherence include: forgetting to take medications, cost factor, side effects, incorrect use of drug, social reasons, denial or poor knowledge of drug regime. If the correct regimen is not prescribed and if patients do not adhere to therapy, then the possibility of resistant strains is high. Improving adherence is therefore arguably the single most important means of optimising overall therapeutic outcomes. Although several studies regarding patient adherence have been performed in the public health care sector, data on adherence in patients from the private health care sector of South Africa remain limited. Many factors influence compliance and identifying these factors may assist in the design of strategies to enhance adherence to such demanding regimens. This study aimed to identify these factors among private sector patients.MethodDescriptive cross-sectional study was conducted among all consenting patients with HIV who visited the rooms of participating private sector doctors from May to July 2005. A questionnaire was administered to consenting participants. Participants who reported missing any medication on any day were considered non-adherent. The data obtained was analysed using SPSS 11.5. A probability value of 5% or less was regarded as being statistically significant. Categorical data was described using frequency tables and bar charts. Pearson's chi-square tests or Fischer's exact tests were used interchangeably as appropriate to assess associations between categorical variables. The study received ethics approval from the University of KwaZulu-Natal's Nelson R Mandela School of Medicine Ethics Committee.ResultsA total of 55 patients completed the questionnaires and 10 patients refused to participate. There was no statistical difference between adherence to treatment and demographics such as age, gender and marital status. In this study 89.1% of patients were classified as non-adherent and reasons for nonadherence included difficulty in swallowing medicines (67.3%) (p = 0.01); side effects (61.8%) (p = 0.03); forgetting to take medication (58.2%) (p = 0.003); and not wanting to reveal their HIV status (41.8%) (p = 0.03). Common side effects experienced were nausea, dizziness, insomnia, tiredness or weakness. Reasons for taking their medicines included tablets would save their lives (83.6%); understand how to take the medication (81.8%); tablets ...

Focus group discussion with private sector doctors in the eThekwini Metro of KwaZulu-Natal on the management of HIV/AIDS patients

“…A study done in the eThekwini Metro of KwaZulu-Natal reported some of the factors that affected adherence to treatment in private sector patients taking ARVs, 6 whilst another study done amongst private sector doctors in the same region during 2005-2006 gave some indication as to how doctors managed their patients and some of the topics they counselled their patients on. 7 The current study therefore aimed to confirm the findings of these two studies and to obtain more in-depth information on the doctors' nonpharmacological HIV management practices.…”

“…Other studies have also found that large and difficult-to-swallow pills or the unpleasant flavour of a suspension have led to noncompliance with treatment. 6,18 Support systems…”

“…Some of the nonpharmacological types of management include counselling on adherence to treatment, nutrition, side-effects of medication, psychosocial issues, family and support systems. 5,6,7 Counselling in HIV/AIDS has become a core element in a holistic model of health care with psychological and emotional support recognised as being integral to patient management and being essential at all stages of the HIV infection. 5,8 Despite the Abstract Background: Highly active antiretroviral treatment (HAART) is essential in the treatment of HIV/AIDS; however, a holistic approach to HIV/AIDS management is important.…”

Application of the Chinese Version of the Pittsburgh Sleep Quality Index in People Living With HIV: Preliminary Reliability and Validity

“…However, side effects associated with ART have also been frequently reported by patients on ART, with sleep disturbances as a common side effect of treatment ( 33 ). A previous study investigating factors influencing adherence to ART mentioned that 56.4% of patients regarded insomnia as an adverse effect of ART, which further contribute to the non-adherence and discontinuation of treatment ( 34 ). Some antiretroviral medications (e.g., efavirenz) have been linked to adverse sleep effects, especially at higher plasma levels ( 35 ).…”

Adherence-monitoring practices by private healthcare sector doctors managing HIV and AIDS patients in the eThekwini metro of KwaZulu-Natal

“…What soon became evident, however, was the vital importance of patient adherence to prescribed medication to obtain full therapeutic benefits. 2 Adherence is associated with patient factors, the regimen, the clinical setting and the strength of the provider-patient relationship 3 and is an equal partnership between the patient and her or his healthcare provider. 4 Various factors are associated with poor adherence, including the following: low levels of literacy; certain agerelated challenges (such as vision loss and cognitive impairment); psychosocial issues (such as depression, homelessness, lower social support, stressful life events, dementia and psychosis); active (but not a history of) substance abuse, particularly for patients experiencing recent relapse; stigma; difficulty with the taking of the medication (such as trouble swallowing the pills and daily schedule issues); complex regimens (such as pill burden, dosing frequency and food requirements); adverse drug effects; and treatment fatigue.…”