Strengthening adherence to Anti Retroviral Therapy (ART) monitoring and support: operation research to identify barriers and facilitators in Nepal

Abstract

BackgroundAnti Retroviral Therapy (ART) is the cornerstone for comprehensive health sector response to Human Immunodeficiency Virus (HIV) treatment, care and support. Adherence of at least 95% is needed to keep HIV under control, as per World Health Organization (WHO) guidelines. This study was aimed at identifying the overall adherence level of, and barriers and facilitators to adherence for patients taking ART in different clinics in all five development regions of Nepal.MethodsA descriptive cross-sectional study was conducted among ART clients receiving free ART from Government of Nepal ART clinics. A total of 435 clients taking ART from twelve ART clinics in different regions of Nepal, aged fifteen years and above were interviewed on one-and-one basis using questionnaires developed in reference to Adult AIDS Clinical Trial Group (AACTG) toolkit among them data from 404 were analyzed after cleaning. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) software where the P value of < 0.05 was accepted as being statistically significant.ResultsThe overall adherence in the last month (missed less than three pills total) was 94.8% (383 out of 404). The main barrier to ART adherence was the fear of side effects (among 61.9% of the non adherent population) which included dizziness (18.1%) and headaches (15.4%). The standard wristwatch (39%) was found to be the most useful aid in enabling timely consumption of medication. Educational status (P = 0.018), drug using habits (P = 0.039) and the conducive environment at ART clinics (P = 0.004) were significantly associated with ART adherence.ConclusionImproving better adherence may require a more holistic approach to treatment regimen and adapting it to patient daily routines. This study identifies issues such as pill count for assessing adherence, better access to health care facilities by clients, better access to medication, as well as improved nutritional support issues for better adherence by the population in the future.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-015-0846-8) contains supplementary material, which is available to authorized users.

Does Providing Free Anti-Retroviral Therapy Ensure Optimal Adherence Among People Living With Hiv / Aids?

“…Being on EFV-based regimens, [8,9]. The reported adherence in the literature varies widely, ranging from 43.2% to 97% [8][9][10][11][12][13][14]. In contrast to the findings of the present study, a study by Sarna et al observed that adherence levels were lower among patients receiving free ART compared to patients paying out of pocket for medication [15].…”

“…Non-adherence was significantly higher among those who ever consumed alcohol (OR: 5.05; confidence interval [CI]: 1.05-24.21; p=0.047). Being on EFV-based regimens, [8,9]. The reported adherence in the literature varies widely, ranging from 43.2% to 97% [8][9][10][11][12][13][14].…”

Harmful alcohol drinking among HIV-positive people in Nepal: an overlooked threat to anti-retroviral therapy adherence and health-related quality of life

“…HIV-positive people had non-adherence to ART when they consumed alcohol in Nepal [22,23]. Alcohol consumption, however, was measured using a single-item scale in Nepal to examine the association of alcohol use and non-adherence using AIDS Clinical Trial Group (ACTG) questionnaires.…”

Factors Influencing Adherence to Antiretroviral Therapy among People Living with HIV in Coastal South India

“…10,12,[21][22][23][24][25][26][27] Better adherence in our settings could be due to the fact that all PLHIV receive free ART, regular adherence monitoring, and better literacy rate and awareness about HIV disease in coastal South India. Our facility is one of the earliest center in coastal south India, taking care of health care needs of PLHIV.…”

“…However, in contrast to our findings, other studies have shown males were more adherent compared to females. 5,21,25,26,27,29 People living with HIV aged more than 40 years were more adherent compared to those who aged 40 years. This could be explained by considering the fact that PLHIV were aware of their HIV status in the later stage of their life because of opportunistic infections and compromised immunity caused by HIV infection.…”