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ARC Journal of AIDS
Volume-1 Issue-1, 2016, Page No: 3-6

Predictors of Adherence to Highly Active Antiretroviral Therapy among Low Income Adult Patient in Arsi Zone

Bekele Dibaba, Mohammed Hussein

Lecturer in Arsi University, Asella, Ethiopia

Citation : Bekele D, Mohammed H. Predictors of Adherence to Highly Active Antiretroviral Therapy among Low Income Adult Patient in Arsi Zone. ARC Journal of AIDS. 2016;1(1):3–6.

Copyright : © 2016 Bekele D, Mohammed H. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Good adherence to antiretroviral therapy reduces the risk of drug resistance. Little is known about the predictors of adherence to highly active antiretroviral therapy among low income patients in Ethiopia. Therefore this study determines the magnitude and predictors of adherence to antiretroviral therapy among these patients in Arsi zone.

Methods: A cross sectional study was carried out from January 1, 2014 to September 20, 2016 among 280 adult PLWHA (≥ 18 years) attending ART clinics in Arsi zone health centers and hospitals. Multiple Logistic regression models were constructed with adherence and independent variables to identify the predictors.

Results: Patients who got family support were 2 times [2.11(1.25-3.58)] more likely to adhere than those who didn’t get family support as an independent predictor of overall adherence (dose and food). The reasons given for missing drugs were 59(21.1%) being away from home and 59(21.1%) being busy with other things.

Conclusion: The adherence rate low income patients were associated with social support. This study highlights emphasis should be given to social supports that help patients to follow their medication.


1.Introduction

Antiretroviral treatment success depends on sustainable high rates of adherence to medication regimen of HAART. However, significant proportions of HIV-infected patients do not reach high levels of adherence and this can lead to drug resistance and public health problems. A meta-analysis study found adherence to ART 60% [1]. Twenty four percent non-adherences has been reported in Southwest Ethiopia [2].

World Health Organization (WHO) recommendations on the use of antiretroviral therapy in resource-limited settings recognize the critical role of adherence in order to achieve clinical and programmatic success[3]. Good adherence to anti- retroviral therapy is necessary to lower the risk of drug resistance[4]. Very high levels of adherence (> 95%) are required for ART to be effective for long term and to prevent the emergence of resistant viral strains[5]. There has been a concern about the capability of patients in resource-limited settings to adhere to ART, especially in the African context [6].

Both clinical experience and emerging data suggest that many patients with chronic HIV disease do no fully adhere to their Highly Active Antiretroviral Therapy (HAART) regimens [7].


2.Materials and Methods

Community based cross-sectional study was conducted in Arsi zone between January 1, 2014 and September 20, 2016 among low income patients on HAART at least for six months. Data were collected using structured questionnaire. The collected data were analyzed using SPSS. Multiple Logistic regressions were done with adherence and the independent variables to identify the predictors. Odds Ratios (OR) and their 95% CI were used to look into the strength of association between the dependent and independent variables. A person was said to be food adherent if he/she always followed dietary instructions agreed upon with the providers, otherwise he/she was labeled as non-adherent. A patient is said to be dose adherent when he/she took ≥ 95% of the prescribed doses correctly otherwise non-adherent. So in this study Adherent is defined as when a PLWHA takes more than 95% of prescribed drug , follows dose restriction and dietary instruction from health care provider for one week prior to the study otherwise Non-Adherent. This type of measurement of adherence has been used in similar setting and adherence in the previous seven days was used for comparison [2].


3.Results and Discussion

In our study patient self-report showed that, 95% of the patients were adherent with ≥ 95% of prescribed doses in the last seven days (Table 2). Study done in north-west Ethiopia shows that the adherence level of hospitalized patients were 80.9%(8). Meta-analysis done in Spain indicated that the overall percentage of adherence was 55%, although this value may be an overestimate(9). Other studies conducted in developed countries demonstrated that the rates of adherence by self-report ranged from 40% to 70% (10). The differences could be due to differences in income.

  

There is good reason to expect that socio-demographic, psychosocial, and clinical variables should be associated with antiretroviral adherence and thus HIV disease activity[11]. In this study patients with family income of 501-1000 were more likely to have an overall adherence than patients less than 500 family income in bivariate analysis (Table 3). Similarly, a recently published meta-analysis [12] examined the association between socio-economic status and adherence to antiretroviral therapy. A study suggested that Special attention need to be given to patients who have lower educational status and are members of households with low income[13]. This indicates that low income is one of the predictors of adherence.

In our study patients who got family support were 2 times more likely to adhere than those who didn’t get the family support (Table 3). Another factor facilitated adherence was support from the family encouraging and helping to remind them to take the treatment. Social support encouraged adherence [41]. Similarly, it has been reported in other studies (2) as social support was a constant predictor of adherence. Lacks of social support have been found to be associated with lower adherence[15]. Social support was associated with greater adherence. A study suggested provision of social support for adherence [16].




4.Concusion

The adherence rate most patients who have low income were associated with social support and family income. This study highlights emphasis should be given to social supports that help patients to improve adherence to their medication.


5.Acknowledgement

My deepest gratitude goes to all data collectors and Respondents. My sincere appreciation goes to my family for their time and continuous encouragement during the whole period of this study.

References

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