Abstract:
Purpose: The objective of this research was to ascertain
perspectives on suboptimal adherence and ways to improve
optimal adherence to antiretroviral drugs (ARVs) among Human
Immunodeficiency Virus (HIV) positive patients attending
selected HIV Care Centres in Kibwezi West Sub-county,
Makueni County, Kenya.
Methodology: Six Focused Group Discussions (FGD)
homogeneously stratified by age and gender and four Key
Informant Interviews (KII) were conducted. Each FGD consisted
of 8 study participants recruited by purposive sampling
technique.
Findings: Focus group discussions identified fear, stigma,
defiance, ignorance on reasons for medication, not believing in
oneself, participating in activities that hinder adherence such as
drinking alcohol, retrogressive religious beliefs, lack of self-love
and denial as the main causes of sub optimal adherence to ARVs.
However the discussions also identified one-on-one educational
counselling sessions, seeking advice, group education with
similar infected people, adherence counselling support by health
workers, acceptance of one’s status, social and family support as
means to improve adherence to ARVs. It also identified knowing
one’s status, acceptance, personal discipline on adherence and
reminders such as clock alarms or a trusted person as means to
improve adherence to ARVs. However, the discussions revealed
gender and age differences, attributed to different life’s
challenges and perspectives in the different cohorts thus
interventions should be targeted rather than lump sum. Key
informant interviews identified ignorance, stigma, busy work
schedule and lack of social support as patient level factors that
would hinder adherence to ARVs. They also noted long waiting
time, distance, poor attitude by health service providers and drug
stock outs contributing to poor adherence to ARVs at the facility
level. However, they identified community dispensing, support
groups, health talks with mentors, psychosocial support, drug
availability, outreach, encouraging disclosure, distribution of
patients to nearest satellite clinics and directly observed therapy
(DOT) by a trusted relative as ways to improve adherence to
ARVs.
Unique Contribution to Theory, Practice and Policy:
interventions need to be tailored to the specific population and
individual needs; thus, adopting better and informed strategies.
The study adds to the pool of knowledge that factors affecting
adherence are dependent on populations under investigation due
to varied socio-demographic, socio-cultural and socio-economic
factors locally, regionally and globally. The findings of the study
will inform the local county government of Makueni and Kibwezi
West Sub-county administrators in formulating local economic
and health policies and by-laws that would aid in improving
optimal adherence to ARVs.
