Social factors affecting ART adherence in rural settings in Zambia

Figures & data

Table 1. Characteristics of study respondents.

	Total (n=518)	Setting for ART
		District hospital (n=260)	Rural health centers (n=258)	P-value
Average age (year)	38.2 (9.2 SD)	38.0 (9.1 SD)	38.6 (9.3 SD)	–
Gender
Male	206 (39.8%)	112 (45.0%)	94 (37.0%)	0.069
Female	297 (57.3%)	137 (55.0%)	160 (63.0%)
Marital status
Single/Divorce/Widowed	248 (47.9%)	129 (52.4%)	119 (47.0%)	0.227
Married/Remarried	251 (48.5%)	117 (47.6%)	134 (53.0%)
Occupation
Government staff member	18 (3.5%)	16 (6.5%)	2 (0.8%)	<0.001
Company employee	16 (3.1%)	12 (4.9%)	4 (1.7%)
Self-employed	68 (13.1%)	48 (19.6%)	20 (8.3%)
Farmer	266 (51.4%)	102 (41.6%)	164 (67.8%)
Housewife	53 (10.2%)	21 (8.6%)	32 (13.2%)
Other	66 (12.7%)	46 (18.8%)	20 (8.3%)
Which do you own
Watch	262 (50.6%)	138 (53.1%)	124 (48.1%)	0.254
Mobile phone	98 (18.9%)	66 (55.0%)	32 (55.0%)	<0.001
Radio	254 (49.0%)	129 (49.6%)	125 (48.4%)	0.791
Television set	109 (21.0%)	83 (55.0%)	26 (55.0%)	<0.001
Average treatment period (month)	12.5 (10.3 SD)	15.2 (10.2 SD)	9.7 (9.7 SD)
Travel expenses for return trip
Free of charge	227 (43.8%)	83 (32.0%)	144 (56.7%)	<0.001
Less than 10,000 Kw	192 (37.1%)	101 (39.0%)	91 (35.8%)
More than 10,000 Kw	94 (18.1%)	75 (29.0%)	19 (7.5%)
Understanding of need to take ARVs regularly at the same time
Yes, complete	502 (96.9%)	251 (96.5%)	251 (98.0%)	0.456
Yes, but incomplete	10 (1.9%)	7 (2.7%)	3 (1.2%)
No	6 (0.8%)	3 (0.8%)	3 (0.8%)
Way to remember when to take ARVs
Watch	245 (47.3%)	123 (47.5%)	122 (47.4%)	<0.001
Clock	79 (15.3%)	44 (16.9%)	35 (13.6%)
Mobile phone	58 (11.2%)	44 (16.9%)	14 (5.4%)
Radio/Television set	72 (13.9%)	20 (7.7%)	52 (20.2%)
Position of the sun	49 (9.5%)	20 (7.7%)	29 (11.3%)
Other	13 (2.5%)	8 (3.1%)	5 (1.9%)
Adherence support
None	99 (19.1%)	69 (26.5%)	30 (11.7%)	<0.001
Family	264 (51.0%)	137 (52.7%)	127 (49.6%)
Other	153 (29.7%)	54 (20.8%)	99 (38.7%)
Perceived stigma of taking ARVs
Never experienced stigma	432 (83.7%)	202 (78.0%)	230 (89.5%)	<0.001
Experienced stigma	84 (16.3%)	57 (22.0%)	27 (10.5%)
Felt pressured to share ARVs
Never pressured	466 (90.5%)	230 (88.8%)	236 (92.2%)	0.191
Felt pressured	49 (9.5%)	29 (11.2%)	20 (7.8%)
Recent Adherence (missed dose in the past four days)
Never missed	458 (88.4%)	233 (90.7%)	225 (88.6%)	0.441
One or more	53 (10.2%)	24 (9.3)	29 (11.4%)

Table 2. Bivariate logistic regression analysis of correlates of non-adherence.

	Missed dose in the past four days		Odds ratio (95% CI)	P-value
	One or more (n=53)	Never (n=458)
Age
More than 38 years	13 (24.5%)	205 (55.2%)	Ref
38 years or less	40 (75.5%)	253 (44.8%)	2.493 (1.299–4.787)	0.005
Gender
Male	15 (28.8%)	188 (42.3%)	Ref
Female	37 (71.2%)	256 (57.7%)	1.812 (0.966–3.401)	0.061
Marital status
Single/Divorce/Widowed	30 (57.7%)	214 (48.5%)	Ref
Married/Remarried	22 (42.3%)	227 (51.5%)	0.691 (0.387–1.236)	0.211
Duration of ART
More than 12 months	30 (56.6%)	276 (60.3%)	Ref
12 months or less	23 (43.4%)	182 (39.7%)	1.163 (0.655–2.065)	0.607
Place of ART
District hospital	24 (45.3%)	233 (50.9%)	Ref
Rural health center	29 (54.7%)	225 (49.1%)	1.251 (0.707–2.215)	0.442
Cost of return trip
Free of charge	18 (36.0%)	204 (44.7%)	Ref
Less than 10,000 Kw	16 (32.0%)	174 (38.2%)	1.043 (0.516–2.105)	0.908
More than 10,000 Kw	16 (32.0%)	78 (17.1%)	2.325 (1.129–4.787)	0.022
Way to remember when to take ARVs
Watch	24 (46.2%)	220 (49.4%)	Ref
Clock	8 (15.4%)	68 (15.3%)	1.078 (0.463–2.511)	0.861
Mobile phone	2 (3.8%)	55 (13.4%)	0.333 (0.076–1.453)	0.144
Radio/Television	10 (19.2%)	61 (13.7%)	1.503 (0.062–3.312)	0.312
Position of the sun	8 (15.4%)	41 (9.2%)	1.789 (0.245–1.256)	0.189
Adherence support
None	15 (10.3%)	84 (18.4%)	Ref
Family	19 (35.8%)	241 (52.7%)	0.441 (0.215–0.908)	0.026
Other	19 (35.8%)	123 (28.9%)	0.806 (0.388–1.678)	0.563
Perceived stigma of taking ARVs
Never experienced stigma	37 (71.2%)	390 (85.2%)	Ref
Experienced stigma	15 (28.8%)	68 (14.8%)	2.325 (1.210–4.467)	0.011
Felt pressured to share ARVs
Never pressured	36 (69.2%)	424 (92.8%)	Ref
Felt pressured	17 (30.8%)	33 (7.2%)	5.710 (2.872–11.353)	<0.001

Table 3. Multivariable logistic regression analysis of correlates of non-adherence.

	Odds ratio (95% CI)	P-value
Age
More than 38 years	Ref
38 years or less	2.646 (1.271–5.508)	0.009
Cost of return trip
Free of charge	Ref
Less than 10,000 Kw	1.081 (0.501–2.336)	0.842
More than 10,000 Kw	2.217 (0.942–5.236)	0.068
Adherence support
None	Ref
Family	0.538 (0.226–1.282)	0.162
Other	1.176 (0.504–2.747)	0.708
Way to remember when to take ARVs
Watch	Ref
Clock	1.477 (0.561–3.891)	0.43
Mobile phone	0.654 (0.142–3.012)	0.585
Radio/Television	2.252 (0.920–5.525)	0.076
Position of the sun	3.311 (1.252–8.772)	0.016
Perceived stigma of taking ARVs
Never experienced stigma	Ref
Experienced stigma	1.06 (0.409–2.747)	0.905
Felt pressured to share ARVs
Never pressured	Ref
Felt pressured	4.390 (1.615–11.933)	0.004