Factors associated with antiretroviral treatment failure among HIV/AIDS patients in Kibera Slums Nairobi County.

Abstract

The efficiency of highly active antiretroviral therapy (HAART) for the human immunodeficiency virus (HIV) is well established, but its effectiveness depends particularly on the adherence of patients to the drugs. Adherence of 95% or greater to antiretroviral drugs is generally considered necessary to achieve optimal virologic suppression in HIV-infected patients. While Kenya has rolled out ART access programs, data on adherence to ART is limited especially considering that new cases of HIV have continued to increase recently. Understanding factors associated with poor adherence is essential to improve patient compliance, maximize virologic suppression, and reduce morbidity and mortality. The main objective of this study therefore was to determine factors associated with non-adherence among adult HIV patients attending the AmrefKibra community based health centre in Nairobi, Kenya. Structured questionnaires were administered to 280 study participants. Data on CD4 cell count before ART initiation was obtained from patients’ health records. Non-adherence to ART was determined by the CASE adherence tool in which patient’s scores were summed up to obtain a composite score that ranged from 3 to 16 points. Patients with Index score≤ 10 points were classified as non-adherent and> 10 adherent. Other data generated from the questionnaire were keyed into SPSS and analyzed for frequencies, cross-tabulations, and chi-square test. Multivariate logistic regression was done to determine the relationship between the independent variables and the dependent variable of the study. Prevalence of non adherence was 18%. Factors that were significantly associated with non adherence include; forgetfulness (19%), side effects (17.5%), pill burden (15.7%), and lack of disclosure (14.6%). Results on CD4 cell count showed that 9.9% of patients with CD4 cell count < 250 exhibited ART non-adherence compared to 8% of the patients with CD4 cell count>250. From multivariate logistic regression analysis the study also showed that inadequate knowledge about the role of ART in HIV management, poor attitudes and practices are associated with non-adherence. In conclusion, factors that were significantly associated with non-adherence in this study were patient related. xviii Forgetfulness was the most common reasons for non-adherence to ART. Therefore, adherence counseling and health information dissemination need to include strategies to minimize forgetfulness using memory aids such as pill boxes and written schedule. Patients should also be informed about the side effects that they are most likely to experience based on the ART regimen they have been put on. A simplified regimen such as two pills once or twice daily should be considered to reduce non-adherence cases associated with pill burden. There is need to develop skill to maintain adherence in the non-disclosure state or design a way to encourage for disclosure. In addition, further studies on adherence rate and its determinants with multiple adherence measurements to resolve the barriers to non-adherence are also recommended. Initiating ART for individuals as soon as they become eligible is important for success of ART program.