Rates and Predictors of Non-Adherence to Antiretroviral Therapy among HIV-Positive Individuals in Kenya: Results from the Second Kenya AIDS Indicator Survey, 2012

Abstract

IntroductionUnderstanding the levels and associated factors of non-adherence to antiretroviral therapy (ART) is crucial in designing interventions to improve adherence and health outcomes of ART. We assessed non-adherence to ART among HIV-infected persons reporting ART use in a nationally representative survey in Kenya.MethodsThe Kenya AIDS Indicator Survey 2012 was a population-based, household survey of persons aged 18 months-64 years conducted in 2012–2013. Self-reported information was collected on demographics, sexual behaviour, HIV status, and ART use. Blood was collected for HIV testing, and if HIV infected, CD4 and viral load testing. HIV-positive specimens were tested for the presence of antiretroviral (ARV) drugs using a qualitative ARV assay using liquid chromatography-tandem mass spectrometry. HIV-positive persons who reported receiving ART but did not have the ARV biomarker present were defined as being non-adherent to their ARV medication. We restricted our analysis to HIV-infected persons aged 15–64 years who reported receiving ART and had laboratory-confirmed results from ARV testing. Multivariate logistic regression was used to identify variables associated with non-adherence.ResultsA total of 648 (5.6%; CI 4.9–6.3) tested HIV-positive of whom 559 (86.3%) had sufficient volume of blood to be tested for ARV drugs. Of those, 271 (47.7%; CI 41.8–53.6) self-reported HIV-positive status during the interview and 186 (69.1%; CI 62.2–76.0) of those reported taking ART. The ARV biomarker was absent in 18 of 186 individuals (9.4%; CI 4.9–13.8) who thus were defined as being non-adherent to ART. Non-adherence was associated with being aged 15–29 years (AOR 8.39; CI 2.26–31.22, p = 0.002) compared to aged 30–64 years, rural residence (AOR 5.87; CI 1.39–25.61, p = 0.016) compared with urban residence and taking recreational drugs in the past 30 days (AOR 5.89; CI 1.30–26.70, p = 0.022).ConclusionOverall, less than 10% of Kenyans aged 15–64 years on ART were not adhering to their HIV medication, highlighting the success of the Kenyan national ART program. Our findings, however, point to the need for targeted interventions particularly for young persons, those in rural areas to improve adherence outcomes, as well as delivery of treatment programs that include psychosocial support as a preventative measure to minimize substance abuse and the risk of treatment failure.

Patterns of detectable viraemia among children and adults with HIV infection taking antiretroviral therapy in Zimbabwe

“…Furthermore, in the present study, adolescents (those aged !10 years) were more likely to experience VF compared to younger children, a finding that has also been reported by other studies conducted in Africa (Makadzange et al, 2015). Adolescence is a period of particularly high risk for poor adherence (Mukui et al, 2016;Nachega et al, 2009). Taken together, these emphasize the need for investigating and addressing factors that impede viral suppression among adolescents.…”

Factors affecting adherence to antiretroviral therapy among pregnant women in the Eastern Cape, South Africa

“…The adherence rate among pregnant women varies across different settings (within and across countries) from 35% to 93.5% [ 15 ]. A study reported low adherence levels among pregnant women in rural Kwazulu Natal, South Africa [ 14 ]; however, a high level of adherence (90%) was reported in Kenya [ 16 ]. An adherence level of 73% during pregnancy was reported in Malawi, but dropped to 66% by three month postpartum [ 17 ].…”

“…The factors associated with non-adherence also vary contextually. For instance, knowledge was linked to non-adherence in Israel [ 25 ], while younger age, rural residence and substance use were important in Kenya [ 16 ]. In Malawi, lack of emotional and financial support from husband, inadequate counseling and internal migration were the reported reasons for non-adherence to ART [ 26 ].…”

Evidence of reduced treatment adherence among HIV infected paediatric and adolescent populations in Nairobi at the onset of the UNAIDS Universal Test and Treat Program

“…Adolescent populations have been shown in previous studies to be the least adherent to ART. A recent national survey in Kenya found higher levels of suboptimal adherence among persons aged 15–29 [ 20 ]. This is in conformity with data from across sub-Saharan Africa which found that ART adherence by pre-teenagers and teenagers is influenced by disclosure [ 21 , 22 ], socioeconomic status [ 23 ], treatment fatigue [ 24 ], fear of stigmatization by peers [ 25 ], and vigilance by the primary caregivers [ 12 , 13 ].…”