Factors affecting adherence of antiretroviral treatment among AIDS patietns in an Ethiopian tertiary university teaching hospital

ArticleinEthiopian medical journal 48(3):187-94 · July 2010with42 Reads
Source: PubMed
Abstract
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.
    • "Achieving adherence to treatment of 95% is not always possible for all people on HAART because of for example lack of family support, unemployment, alcohol intake, poverty and the presence of other conditions and diseases that could limit insight and knowledge [7]. In Ethiopia, studies indicate that the level of adherence is suboptimal for patients on HAART ranging from 7–28% based on self-report and/or pill count78910111213. The longer a person is on a failing HAART regimen, the higher the mortality risk [14] . "
    [Show abstract] [Hide abstract] ABSTRACT: Immunological monitoring is part of the standard of care for patients on antiretroviral treatment. Yet, little is known about the routine implementation of immunological laboratory monitoring and utilization in clinical care in Ethiopia. This study assessed the pattern of immunological monitoring, immunological response, level of immunological treatment failure and factors related to it among patients on antiretroviral therapy in selected hospitals in southern Ethiopia. A retrospective longitudinal analytic study was conducted using documents of patients started on antiretroviral therapy. Adequacy of timely immunological monitoring was assessed every six months the first year and every one year thereafter. Immunological response was assessed every six months at cohort level. Immunological failure was based on the criteria: fall of follow-up CD4 cell count to baseline (or below), or CD4 levels persisting below 100 cells/mm3, or 50% fall from on-treatment peak value. A total of 1,321 documents of patients reviewed revealed timely immunological monitoring were inadequate. There was adequate immunological response, with pediatric patients, females, those with less advanced illness (baseline WHO Stage I or II) and those with higher baseline CD4 cell count found to have better immunological recovery. Thirty-nine patients (3%) were not evaluated for immunological failure because they had frequent treatment interruption. Despite overall adequate immunological response at group level, the prevalence of those who ever experienced immunological failure was 17.6% (n=226), while after subsequent re-evaluation it dropped to 11.5% (n=147). Having WHO Stage III/IV of the disease or a higher CD4 cell count at baseline was identified as a risk for immunological failure. Few patients with confirmed failure were switched to second line therapy. These findings highlight the magnitude of the problem of immunological failure and the gap in management. Prioritizing care for high risk patients may help in effective utilization of meager resources.
    Full-text · Article · May 2015
    • "Reasons claimed by participants for missing doses include forgetting [14,17,19202125], being ill [2], being busy [2,3,21,25] and running out of medication [15,19,22], being away from home [21,23,25] and Lack of transport cost. For details of information referTable 2. Citation: Serawit Deyno, Alemayehu Toma (2014) Adherence to Antiretroviral Therapy in HIV-Positive Patients in Ethiopia: Review. "
    Full-text · Article · Jan 2014 · BMC Health Services Research
    • "Our results suggest that the problem lied in the exclusion of qualitative information in the questionnaire design. Of the 34 studies included in this review, 271213141516171820,22232427,28,3031323334353638394041424344 used validated measures from previous quantitative studies to derive their questionnaires and only seven studies, three, in low income countries [11,19,21] and four in high income countries [25,26,29,37] , conducted an informative phase, using qualitative methods, to inform the questionnaire development. The exclusion of qualitative information during the questionnaire design in the rest of the studies could have led to over-emphasis in the research of the same kind of easily measured variables. "
    [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. Methods 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. Results 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. Conclusions 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.
    Full-text · Article · May 2013
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