Adherence to art and its determinants among hiv infected patients at dessie referral hospital, north central Ethiopia

Abstract

Background: The use of antiretrovirals in combination therapy decisively altered the course of HIV infection epidemics. Adherence to ART regimens over an extended period is a key factor in obtaining their health benefits. Adherence to ART improves clinical results, controls the progression of disease and reduces mortality rates, resulting in improved patient quality of life. Objective: to measure the levels of adherence and assess determinant factors leading to nonadherence to antiretroviral therapy at Dessie Referral Hospital, North Central Ethiopia. Methodology: A cross-sectional study that engaged qualitative and quantitative data collection methods was carried out from February 07 to March 31, 2011in Dessie Referral Hospital. Self report and unannounced pill count techniques were used to measure the adherence level. Bivariate logistic regression analysis was undergone to determine presence of statistically significant association between possible determinant factors and adherence rate to antiretrovirals. Qualitative data was transcribed and analyzed using themes. Results: The majority of the participants were females, 172 (56.8%). 277 (91.4%) of the respondents were optimally adherent to ART by 3-days self-report and 142(85.0%) of the 167 participants were optimally adherent by unannounced pill count method. Binary logistic regression analysis revealed that non disclosure of HIV status (AOR=14.15, CI (3.64, 54.98), P=0.001), lack of support (AOR=3.19, CI (1.07, 33.73), P=0.042), perceived side effects due to antiretrovirals (AOR=4.93, CI (1.34, 18.19), P=0.017) and inadequate knowledge about ART (AOR=5.64, CI (1.08, 296.26), P=0.001) were associated with non-adherence to doses of ARVs. Conclusion and Recommendations: The optimal adherence level achieved by 3-days self report and unannounced pill count were 91.4% and 85.0%, respectively. Disclosure of HIV status, social support and disclosure, knowledge about ART and reported side effects due to ARVs were found to be associated with adherence in HIV-infected patients. Optimal adherence was found to be associated with better quality of life and increased CD4 count. Government and stakeholders working on HIV/AIDS should include food and transport support to ARV users and healthcare providers should inform patients about possible side effects and manage these side effects as early as possible so that users can maintain good adherence rate.