Factors Associated with Non-Adherence to Antiretroviral Treatment in Adults at Keetmanshoop District State Hospital in Namibia

Abstract

BackgroundNamibia's Anti-Retroviral Therapy (ART) roll out has been very successful, achieving more than 84% coverage against a national target of 90% [1]. However, despite the successful role out of ART in Namibia, patients often fail to meet the level of adherence required for successful ART. The challenge of non-adherence to ART treatment has also been noted at the study site. In a study done in Nigeria, outcomes of non-adherence to ARV medication included viral resistance, treatment failure, toxicities and waste of financial resources [2]. Results from a study conducted in Botswana concluded that there is a strong correlation between adherence and clinical outcomes [3]. Given the large number of patients whose HIV infection will progress to AIDS if adherence is suboptimal, research is urgently needed to determine factors influencing adherence so that the most effective interventions to ensure adherence in African cohorts can be employed [4]. In a study in Ethiopia, 26.5% of the respondents had sub optimal adherence [5]. Locally, a recent study from Northern Namibia reported that 22% of respondents were non-adherent measured by pill count assessment. Henceforth this study envisaged to identify factors associated with non-adherence to ARV treatment in adult patients at Keetmanshoop hospital in Namibia.Focusing on the study site, in January 2015, the Keetmanshoop Hospital had 1289 adults receiving ART. On average, the clinic serves about 250 to 400 patients in a month. In the period October to December 2014 a total of 933 patients received follow-up care at the study site. Of these patients 53% (n=530) achieved required adherence scores of more than or equal to 95% while approximately 47% (n=403) achieved less than the required 95%. The suboptimal adherence rate in 47% of the patients 36.7% found in January 2015 at the Keetmanshoop Hospital was significantly higher than that reported in the Northern parts of the country. The Health Belief Model (HBM) was the theory of choice in this study due to its applicability to patient adherence and preventative health practices. The HBM has four major components [6,7]. HSOA Journal of AIDS Clinical Research and STDs Research ArticleAbstract Aim: To identify the factors associated with non-adherence to Antiretroviral Treatment (ART) amongst adult patients at a hospital in Namibia.Methods: Quantitative and qualitative approaches were employed, study sample of 112 adults aged 21 years and older at Keetmanshoop District State Hospital participated. Adherence to ART was assessed using the pill count and self-report methods. A questionnaire with a Cronbach value of 0.8 was used. Census and multi-stage sampling was applied. Data was collected from August to September 2016 through structured interviews and patients records review. Correlation of variables was done to remove multicollinearity. Stata version 12 was used for logistic regression to do univariate and multivariate analysis to determine factors associated with missing five or more doses. Results:In the univariate analy...