Association of ART non-adherence with self-reported behavior and lifestyle among injecting drug users in the coastal region of Kenya

Abstract

There is a public health concern with the possible widespread of Antiretroviral Therapy (ART) drug-resistance. The widespread resistance could be due to risky behavior and lifestyle of Injecting Drug Users (IDUs) resulting into non-adherence to ART. However, few studies have investigated association of ART non-adherence with the risky behavior and lifestyle of IDUs. A cross-sectional study design was adopted to investigate ART non-adherence association with the risky behavior and lifestyle among 200 IDUs from Malindi in the coastal region of Kenya. Structured questionnaire was used to collect data while exponential discriminative snowball sampling was used for the recruitment of the study participants. Self-reported non-adherence was defined as taking less than 90% of daily ART doses, variable such as missed or stopped ART was used. Chi-square (χ2) tests were used to establish the relationship between various risk behaviors and ART adherence, while binary logistic regression model was used to test the association between independent variables (risky behavior and lifestyle) and dependent variable (ART non-adherence). A significant number 32% of the study participants reported non-adherence to ART, with 17% practicing risky sexual behaviors, 14% being commercial sex workers (CSW) while 89% had multiple sexual partners. Non-adherence to ART was associated with duration of drug use (OR = 6.73; 95%Cl = 1.93-23.0; P = 0.003), IDU/CSW (OR = 6.04; 95%Cl = 3.65-10.0; P = 0.001), needle sharing (OR = 2.96; 95%Cl = 1.60-5.46; P = 0.001) and commercial sex work (OR = 2.16; 95%Cl = 1.40-4.81; P = 0.001). This study reveals that multiple sex, commercial sex, same gender sex, imprisonment, needle share in prison, being in rehabilitation and duration on ART are associated with ART non-adherence among IDUs. Consequently, health education should focus on behavior and lifestyle change to avert potential widespread drug resistance within and beyond the population of IDUs.