Higher level of antiretroviral adherence is associated with improved virological, immunological and clinical outcomes. Despite the availability of few studies in sub Saharan Africa the factors for poor adherence are diverse.
To determine adherence factors for antiretroviral treatment in Hawassa University teaching hospital in southern Ethiopia.
A cross sectional study was undertaken on total of 510 AIDS patients seen over one month period Data were collected using a structured questionnaire and analysis was done using SPSS 15.0.
Out of interviewed patients 88.2% of them had > or = 95% and 97.1% of them had > or =80% antiretroviral adherence rate by self report over one month period. The major reasons for missing drugs in 79.8% were forgetting to take drug, gastrointestinal symptoms, give priority for praying, being hopeless and inadequate adherence counseling Significant predictors of poor adherence were lower level of knowledge about adherence, absence of job and 'Sidamnigna' as primary language. It is also observed that trend of adherence decreased as level of education decrease.
Adherence rate found in this study is higher than many developed and developing countries and equivalent to other studies done in Ethiopia. Those who speak local language, jobless and having low education level may require intensive counseling to optimize their adherence.
"A total of 29 studies (85%) were clinic based [11-16,18-21,24-35,37-40,42] and five (15%) were situated at community level [17,22,23,36,44]. Twenty-four studies (70%) focused on adherence to ART [11-15,20,21,24-30,32-39,41-43], five studies (15%) focused on uptake of voluntary and counselling testing (VCT) [17,22,23,36,44], four (11%) on ART initiation [16,18,19,26] and one (3%) on attrition . Table 1 displays the characteristics of the studies. "
[Show abstract][Hide abstract] ABSTRACT: Background
The role of socio-cultural factors in influencing access to HIV/AIDS treatment, care and support is increasingly recognized by researchers, international donors and policy makers. Although many of them have been identified through qualitative studies, the evidence gathered by quantitative studies has not been systematically analysed. To fill this knowledge gap, we did a systematic review of quantitative studies comparing surveys done in high and low income countries to assess the extent to which socio-cultural determinants of access, identified through qualitative studies, have been addressed in epidemiological survey studies.
Ten electronic databases were searched (Cinahl, EMBASE, ISI Web of Science, IBSS, JSTOR, MedLine, Psyinfo, Psyindex and Cochrane). Two independent reviewers selected eligible publications based on the inclusion/exclusion criteria. Meta-analysis was used to synthesize data comparing studies between low and high income countries.
Thirty-four studies were included in the final review, 21 (62%) done in high income countries and 13 (38%) in low income countries. In low income settings, epidemiological research on access to HIV/AIDS services focused on socio-economic and health system factors while in high income countries the focus was on medical and psychosocial factors. These differences depict the perceived different barriers in the two regions. Common factors between the two regions were also found to affect HIV testing, including stigma, high risk sexual behaviours such as multiple sexual partners and not using condoms, and alcohol abuse. On the other hand, having experienced previous illness or other health conditions and good family communication was associated with adherence to ART uptake. Due to insufficient consistent data, a meta-analysis was only possible on adherence to treatment.
This review offers evidence of the current challenges for interdisciplinary work in epidemiology and public health. Quantitative studies did not systematically address in their surveys important factors identified in qualitative studies as playing a critical role on the access to HIV/AIDS services. The evidences suggest that the problem lies in the exclusion of the qualitative information during the questionnaire design. With the changing face of the epidemic, we need a new and improved research strategy that integrates the results of qualitative studies into quantitative surveys.
BMC Health Services Research 05/2013; 13(1):198. DOI:10.1186/1472-6963-13-198 · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Alcohol consumption adds fuel to the HIV epidemic in sub-Saharan Africa (SSA). SSA has the highest prevalence of HIV infection and heavy episodic drinking in the world. Alcohol consumption is associated with behaviors such as unprotected sex and poor medication adherence, and biological factors such as increased susceptibility to infection, comorbid conditions, and infectiousness, which may synergistically increase HIV acquisition and onward transmission. Few interventions to decrease alcohol consumption and alcohol-related sexual risk behaviors have been developed or implemented in SSA, and few HIV or health policies or services in SSA address alcohol consumption. Structural interventions, such as regulating the availability, price, and advertising of alcohol, are challenging to implement due to the preponderance of homemade alcohol and beverage industry resistance. This article reviews the current knowledge on how alcohol impacts the HIV epidemic in SSA, summarizes current interventions and policies, and identifies areas for increased research and development.
Current HIV/AIDS Reports 06/2011; 8(3):172-80. DOI:10.1007/s11904-011-0088-2 · 3.80 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: It is not clear what effect socioeconomic factors have on adherence to antiretroviral therapy (ART) among patients in low- and middle-income countries. We performed a systematic review of the association of socioeconomic status (SES) with adherence to treatment of patients with HIV/AIDS in low- and middle-income countries. We searched electronic databases to identify studies concerning SES and HIV/AIDS and collected data on the association between various determinants of SES (income, education, occupation) and adherence to ART in low- and middle-income countries. From 252 potentially-relevant articles initially identified, 62 original studies were reviewed in detail, which contained data evaluating the association between SES and adherence to treatment of patients with HIV/AIDS. Income, level of education, and employment/occupational status were significantly and positively associated with the level of adherence in 15 studies (41.7%), 10 studies (20.4%), and 3 studies (11.1%) respectively out of 36, 49, and 27 studies reviewed. One study for income, four studies for education, and two studies for employment found a negative and significant association with adherence to ART. However, the aforementioned SES determinants were not found to be significantly associated with adherence in relation to 20 income-related (55.6%), 35 education-related (71.4%), 23 employment/occupational status-related (81.5%), and 2 SES-related (100%) studies. The systematic review of the available evidence does not provide conclusive support for the existence of a clear association between SES and adherence to ART among adult patients infected with HIV/ AIDS in low- and middle-income countries. There seems to be a positive trend among components of SES (income, education, employment status) and adherence to antiretroviral therapy in many of the reviewed studies.
Journal of Health Population and Nutrition 06/2013; 31(2):150-70. DOI:10.3329/jhpn.v31i2.16379 · 1.04 Impact Factor
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