Determinants of Adherence to Antiretroviral Drugs among HIV Positive Patients Attending Selected Comprehensive Care Centres in Kibwezi West Sub-County, Makueni County, Kenya

Abstract

Management of Human Immunodeficiency Virus (HIV) is multipronged but its nerve centre is lifelong adequate and consistent use of antiretroviral drugs (ARVs). Poor adherence to ARVs is a significant public health concern in the control of HIV infection. Understanding the factors that contribute to adherence to ARVs is crucial in strengthening methods to improve adherence. The overall objective of this study was to determine the factors associated with adherence to antiretroviral drugs among HIV positive patients attending selected Comprehensive Care Centres (CCC) in Kibwezi West Sub-county, Makueni County, Kenya. Factors determining adherence range from individual-level factors, clinical-level factors to facility-level factors. Therefore, in addressing adherence, interventions need to be tailored to the specific population and individual needs and not a lump sum. On hundred and seventy three (173) respondents were recruited by systematic random sampling and interviewed. Six Focused Group Discussions (FGD) and four Key Informant Interviews (KII) were also conducted. Data was collected from patients and patient’s sick sheet using interviewer administered questionnaires and data abstraction sheets respectively. FGDs and KIIs guides were used to collect qualitative data. Quantitative data was entered, cleaned and stored in an excel database in a password protected login system. Confidentiality was maintained. Data was analysed using SPSS version 20.0. Descriptive statistics and Inferential statistics by Pearson’s Chi-square test of association and binary logistic regression with a level of significance set at p<0.05 were done. Qualitative data from FGDs and KIIs was analysed by Computer-assisted qualitative data analysis software (CAQDAS) software (Code Analysis Toolkit) and a manual oversight based on thematic and core analysis. Out of the 173 respondents interviewed, majority 163(94.2%) of the respondents were adherent to ARVs. There was a significant association between adherence to ARVs and sex {χ 2 (1) =4.636, p<0.05. Males were twice as likely to have sub-optimal adherence to ARVs compared to females {aOR 2.4(95% CI 1.1, 5.5)}. Age was significantly associated with adherence {Likelihood Ratio G2 (4) =10.693, p<0.05}. Respondents aged 65 years and above were 33 times likely to adhere to ARVs than respondents aged 15-17 years {aOR 33.3(95%CI 10.6, 111.1)}. Living in the same house with someone on ARVs was significantly associated with adherence to ARVs {χ 2 (1) =3.997 p=<0.05}. Respondents not living in the same house with someone on ARVs were 11 times likely to have sub-optimal adherence to ARVs compared to those living with someone on ARVs in the same house{aOR 11.1 ((95%CI (6.3,19.6)}. There was no significant association between clinical factors and adherence to ARVs. Qualitative parameters such as stigma, busy work schedule, poor attitude by health service providers, drug stock outs, distance and long waiting time were facility-level factors associated with sub-optimal adherence to ARVs. In conclusion, the near optimal level of adherence to ARVs portends good progress in the fight against the HIV scourge. Being of female gender, older age (above 65 years) and sharing a roof with someone on ARVs predicted better adherence to ARVs among patients attending selected CCCs in Kibwezi-West Sub County. This study recommends further studies with additional variables to improve adherence among the male and younger population. In addition, education and awareness creation on importance of adherence to ARVs is recommended for sustained optimal adherence.