Abstract:
Adherence to antiretroviral medications is important in transforming and expanding
treatment programmes for both individual and public health benefit. The medications
are known to reduce the risk of transmission of HIV and reduce AIDS related
mortality if adhered to. This study set out to determine factors that influence
treatment adherence, based on self-reporting assessment among male sex workers on
Antiretroviral Therapy in Nairobi City County, Kenya. Using a cross-sectional study
design, quantitative and qualitative research methods, 260 male sex workers
receiving antiretroviral therapy, were selected through respondents driven sampling
and interviewed using a semi- structured questionnaire. Three focused group
discussions with 37 male sex workers and 12 key informant interviews (3 clinicians,
3 pharmacist, 3 counsellors and 3 treatment site managers) were conducted. The
quantitative date was analyzed using Statistical Product and Service Solutions
(SPSS) version 12 and thematic analysis done for qualitative data. Univariate,
bivariate, and multivariable analyses assed the proportion of adherence and correlates
of self- reported adherence. Chi-square test and Fisher’s exact test was done and Pvalues set at < 0.05 was considered statistically significant. Odds ratios were used to
show the strength of association. Factor analysis was done to extract most important
barriers of adherence. The proportion of male sex workers who self-reported
adherence was established at 40% (104) as compared to non-adherence of 60%
(158). Factors that influenced self-reported adherence among the male sex workers
were Antiretroviral therapy associated cost ART (χ2 = 10.767, d.f=1, p=0.001;)
knowledge on HIV and ART (Fishers Exact Test p=0.045) alcohol and drug abuse
Fisher Exact Test (p<0.001); perceived poor treatment by ART health provider (χ2 =
4.9364; d.f=1; p=0.026) and ever had a clinical monitoring test of CD4 count (χ2
=11.143;d.f=1;p=0.001) and main reason for getting into sex work (χ2 =5.715, d.f=1
p=0.017) and perceived barriers of ART (p<0.00) Fisher Exact Test). Those who
score highest on knowledge of HIV and ART were more likely (OR 2.1; 95% CI;
1.1-3.8) compared to those who scored the least. Those who reported clinical
monitoring through CD4 count were more likely (OR 3.4; 95% CI; 1.6-7.2) while
those who abused alcohol and drugs and perceived they are poorly treated by the
xvii
ART provider were unlikely to adhere. Experience of side effects, lack of support or
care, sharing of pills and lack of time to attend clinics (p<0.001Fisher’s Exact Test)
were identified as the key barriers correlated to self-reported non-adherence. The use
of multidimensional male sex workers centered treatment model that addresses
structural barriers such as cost related to antiretroviral access, sensitizing of health
care workers against homophobic tendencies and integrated with interventions to
address alcohol and drug abuse and is recommended.