Faculty of Health Science
School of Public Health
0310820y
gapawi@yahoo.com / Introduction: A study of adherence was conducted at the HIV Clinic of Helen Joseph
Hospital, Johannesburg between June and September 2004. First it measured the level of
adherence of patients (referred to as participants in this report) to antiretroviral medications.
The relationship between adherence results and the viral load of the participants was
explored. Factors such as treatment regimens, patient-provider relationship, patients’
knowledge of HIV treatment, disclosure of HIV status and support for HIV positive
individuals were also studied with regard to adherence to antiretroviral therapy.
Methods: Out of a total eligible pool of 198 patients, 184 patients were included in the
study, representing 92.9% response rate. Participants were interviewed using a questionnaire
and their HIV RNA concentrations (viral loads) ascertained. Adherence was defined as >=
95% (higher adherence) if a participant missed 0-2 medication doses and < 95% (lower
adherence) if >2 doses were missed over a 23-day recall period.
Results: Reported missed medication doses = 0 for 82.6% (152/184), 1 for 9.6% (14/184),
2 for 2.2% (4/184), 3 for 3.8% (7/184), 4 for 2.2% (4/184), 5 for 1.1% (2/184) and 11 for
0.5% (1/184) of the sample. The adherence level of 92.4% (170/184) of the sample was >=
95% and that of 7.6% (14/184) was < 95% of expected doses. A total of 116 participants had
undetectable HIV RNA concentrations (i.e. viral load <50 copies/ml) and 64 had detectable
viral load. Among the higher adherence category of participants 67.7% (113/167) had
undetectable viral load compared with 23.1% (3/13) of the lower adherence category (χ2 =
10.46; p = 0.002). Participants who reported lower adherence had a mean log10 viral load of
2.90 compared to the higher adherence category with a mean log10 viral load of 0.81
(p<0.001). The mean duration of treatment for lower adherence category of participants was
v
7.2 months compared with 13.3 months for the higher adherent participants (p = 0.025).
Overall, participants with higher adherence were over six times more likely than those with
lower adherence of achieving undetectable plasma HIV RNA (OR = 6.98; p = 0.004).
Inadequate knowledge about HIV treatment where participants never heard of treatment
adherence (p = 0.001), viral load (p = 0.001), or Cd4 cell count (p < 0.001); where
participants believed that drugs cure HIV (p = 0.026), that one can stop treatment if one feels
better (p < 0.001); and participants not knowing that HIV treatment is for life (p < 0.001)
were associated with lower adherence. Other factors which predicted lower adherence were
dietary restrictions (p = 0.007), drug side effects (p < 0.001), forgetting medication doses (p
= 0.001) and missing clinic appointments (p = 0.001). Higher adherence was more likely to
be reported where provider could speak patients’ preferred language (p = 0.035), assist
patients with treatment difficulties (p = 0.002) and where provider was seen to be not too
busy to listen to patients (p = 0.044). The method by which patients received information
about HIV and its treatment did not affect reported adherence levels (p = 0.805). Disclosure
of HIV status to both partner and family member (p < 0.001), and receiving social support
from family members (p = 0.007) were found to be associated with reported higher
adherence. Socio-demographic characteristics such as age (p = 0.174), gender (p = 0.159),
level of formal education (0.107) as well as economic characteristics such as earning money
(p = 0.104) and having a telephone (p = 0.124) were not associated with adherence to
antiretroviral medications.
Conclusion: This study suggests that the HIV-positive patients in the HIV clinic of Helen
Joseph Hospital can maintain a high level of adherence to regimen of antiretroviral
treatment. However, there is a need to develop strategies to enhance educational
vi
programmes and strengthen knowledge of HIV treatment among lower adherence category
of patients, and to improve patients’ self-management and care for mediation pills. Further
research is recommended to assess broader psychosocial factors predicting adherence in this
population, and to ascertain what really happens to ARV pills dispensed to patients.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/1836 |
| Date | 17 November 2006 |
| Creators | Akpomiemie, Godspower |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
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