Medication Adherence and Risk Factors for Non-adherence among Patients taking Highly Active Antiretroviral Therapy

ABSTRACT

Background: ART is a life long treatment and its effectiveness depends critically both on the efficacy of the antiretroviral drugs against the virus, and achieving a very high level of adherence (> 95 %) to the medications. Adherence poses a special challenge and requires commitment from the patient and the health care provider.Objectives: The study evaluated medication adherence, and identified risk factors for non-adherence in HIV-infected ART patients.Methods: In a cross-sectional survey, medication adherence of 118 HIV-infected ART patients who received pretreatment and ongoing adherence counseling and education for 6 months was evaluated using a self-administered studyspecific 16-item questionnaire. Self-reported adherence was calculated as the mean of patients' adherence to the medication schedule and the number of prescribed doses of medications missed. Chi-square statistics was used to test the association of adherence with occupation and education at 95 % CI.Results: The mean age of participants was 33.9 (95 % CI, 29.6-38.2) years; and 82.2 % of participants were aged 26-45years; 60.2 % females, 80.5 % attained secondary education at the least; and 77.1 % were employed. All participants reported been counseled on the benefits of ART and medication adherence at ART initiation. On assessment of participants' knowledge of the benefits of ART and medication adherence, 92.2 % were very knowledgeable, 2.9 %reported wrongly that ART is a cure for HIV. The self-reported adherence to medication schedule was 68.9 %(range 0 % - 100 %), of which 83 (70.3 %) reported > 75 % adherence; while adherence to prescribed doses of medications was 89.2 % (range 20 % - 100 %), of which 100 (84.7 %) participants reported > 80 % adherence. Mean self-reported adherence (±SD) was 79.1 % ± 14.4 %. Employment status was associated with poor adherence (P < 0.05), unlike the educational status. The major reasons reported for non-adherence were busy at work or school (33.1 %), forgetfulness (15.5 %), fasting (12.0 %), and travelled away from home (10.6%). Conclusion: The self-reported adherence was relatively poor compared to the desired value of > 95%. Employment status was associated with poor adherence and this may be corroborated by the major reason reported for non-adherence (busy at work or school). Routine adherence monitoring and multiple adherence interventions in clinical practice are recommended