Abstract
BackgroundAntiretroviral therapy (ART) requires high-level (> 95%) adherence. Kenya is rolling out ART access programmes and, issue of adherence to therapy is therefore imperative. However, published data on adherence to ART in Kenya is limited. This study assessed adherence to ART and identified factors responsible for non adherence in Nairobi.MethodsThis is a multiple facility-based cross-sectional study, where 416 patients aged over 18 years were systematically selected and interviewed using a structured questionnaire about their experience taking ART. Additional data was extracted from hospital records. Patients were grouped into adherent and non-adherent based on a composite score derived from a three questions adherence tool developed by Center for Adherence Support Evaluation (CASE). Multivariate regression model was used to determine predictors of non-adherence.ResultsOverall, 403 patients responded; 35% males and 65% females, 18% were non-adherent, and main (38%) reason for missing therapy were being busy and forgetting. Accessing ART in a clinic within walking distance from home (OR = 2.387, CI.95 = 1.155-4.931; p = 0.019) and difficulty with dosing schedule (OR = 2.310, CI.95 = 1.211-4.408, p = 0.011) predicted non-adherence.ConclusionsThe study found better adherence to HAART in Nairobi compared to previous studies in Kenya. However, this can be improved further by employing fitting strategies to improve patients' ability to fit therapy in own lifestyle and cue-dose training to impact forgetfulness. Further work to determine why patients accessing therapy from ARV clinics within walking distance from their residence did not adhere is recommended.
Highlights
Antiretroviral therapy (ART) requires high-level (> 95%) adherence
Twenty four percent non-adherence has been reported in Southwest Ethiopia [2], 22% in Cote d’Ivore [3] and 13% in Cameroon [4]
Prevalence of nonadherence found in this study (18%) is comparable to the continental prevalence (23%) for Africa [1], 21% in Southwest Ethiopia [2] and 22% in Cote d’Ivore [3]
Summary
Antiretroviral therapy (ART) requires high-level (> 95%) adherence. Kenya is rolling out ART access programmes and, issue of adherence to therapy is imperative. Published data on adherence to ART in Kenya is limited. This study assessed adherence to ART and identified factors responsible for non adherence in Nairobi. Antiretroviral treatment success depends on sustainable high rates of adherence to medication regimen of ART [1]. Significant proportions of HIV-infected patients do not reach high levels of adherence and this can lead to devastating public health problems. Byakika et al [5] reported 68% adherence to HIV treatment in Uganda, 54% in Nigeria [6] and 63% in South Africa [7].
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