Abstract
Background
Treatment adherence is critical for the success of antiretroviral therapy (ART) for people living with HIV. There is limited representative information on ART drug adherence and its associated factors from Southern Ethiopia. We aimed at estimating the level of adherence to ART among people living with HIV and factors associated with it in 20 randomly selected ART clinics of Southern Ethiopia.
Methods
In this cross-sectional study, we interviewed consecutive HIV patients on first-line antiretroviral regimen attending the clinics in June 2014 using a pretested and structured questionnaire. For measuring adherence, we used 4-day recall method based on “The AIDS Clinical Trial Group adherence assessment tool”. Patients were classified as “Incomplete adherence” if they missed any of the doses in the last 4 days. Data were singly entered using EpiData and descriptive analysis, and unadjusted odds ratios were calculated using EpiDataStat software. Multivariate logistic regression analysis was performed using Stata v12.0.
Results
Of 974 patients interviewed, 539 (56%) were females, and mean age was 35 years. The proportion of patients with incomplete adherence was 13% (95% confidence interval: 11%–15%). In multivariate analysis, factors significantly associated with incomplete adherence included young age, being Protestant Christian, consuming alcohol, being single, and being a member of an HIV association. Psychosocial factors like stigma, depression, and satisfaction to care were not associated with incomplete adherence in the current context.
Conclusion
The overall adherence to ART was good. However, there were certain subgroups with incomplete adherence who need special attention. The health care providers (especially counselors) need to be aware of these subgroups and tailor their counseling to improve adherence among these groups. Exploratory qualitative studies may help uncover the exact reasons for incomplete adherence.
Acknowledgments
This research was conducted through the Structured Operational Research and Training Initiative (SORT IT), a global partnership led by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization (WHO/TDR). The model is based on a course developed jointly by the International Union Against Tuberculosis and Lung Disease (The Union) and Médecins sans Frontières (MSF). The specific SORT IT program which resulted in this publication, was jointly developed and implemented by The Centre for Operational Research, The Union, Paris, France; The Operational Research Unit (LUXOR), Medécins Sans Frontières, Brussels Operational Center, Luxembourg; The Union, South-East Asia Regional Office, New Delhi, India; and The Centre for International Health, University of Bergen, Norway. Finally, we acknowledge the data collectors, ART clinic health workers, and heads of the health facilities for their cooperation during the data collection.
The original study was funded by the Ethiopian Federal HIV/AIDS Prevention and Control Office (FHAPCO). The SORT IT program was supported and funded by Bloomberg Philanthropies, The Union, MSF, the Department for International Development (DFID), UK, and the World Health Organization. La FondationVeuve Emile Metz-Tesch supported open-access publications costs. The funders had no role in study design, data collection, and analysis, decision to publish, or preparation of the manuscript.
Disclosure
The authors report no conflicts of interest in this work.