Date Published: December 5, 2011
Publisher: BioMed Central
Author(s): Samwel N Wakibi, Zipporah W Ng’ang’a, Gabriel G Mbugua.
Antiretroviral therapy (ART) requires high-level (> 95%) adherence. Kenya is rolling out ART access programmes and, issue of adherence to therapy is therefore imperative. However, published data on adherence to ART in Kenya is limited. This study assessed adherence to ART and identified factors responsible for non adherence in Nairobi.
This is a multiple facility-based cross-sectional study, where 416 patients aged over 18 years were systematically selected and interviewed using a structured questionnaire about their experience taking ART. Additional data was extracted from hospital records. Patients were grouped into adherent and non-adherent based on a composite score derived from a three questions adherence tool developed by Center for Adherence Support Evaluation (CASE). Multivariate regression model was used to determine predictors of non-adherence.
Overall, 403 patients responded; 35% males and 65% females, 18% were non-adherent, and main (38%) reason for missing therapy were being busy and forgetting. Accessing ART in a clinic within walking distance from home (OR = 2.387, CI.95 = 1.155-4.931; p = 0.019) and difficulty with dosing schedule (OR = 2.310, CI.95 = 1.211-4.408, p = 0.011) predicted non-adherence.
The study found better adherence to HAART in Nairobi compared to previous studies in Kenya. However, this can be improved further by employing fitting strategies to improve patients’ ability to fit therapy in own lifestyle and cue-dose training to impact forgetfulness. Further work to determine why patients accessing therapy from ARV clinics within walking distance from their residence did not adhere is recommended.
Antiretroviral treatment success depends on sustainable high rates of adherence to medication regimen of ART . However, significant proportions of HIV-infected patients do not reach high levels of adherence and this can lead to devastating public health problems. Mills et al in a meta-analysis study found a combined continental adherence to ART of 64% with 55% adherence in North America and 77% in Africa. Twenty four percent non-adherence has been reported in Southwest Ethiopia , 22% in Cote d’Ivore  and 13% in Cameroon . Byakika et al  reported 68% adherence to HIV treatment in Uganda, 54% in Nigeria  and 63% in South Africa . Non-adherence to ART has been associated to diverse factors including patient related factors, health condition/disease, health care system and healthcare teams, therapy/treatment and Socio-economic factors [5,6,8-10]. Kenya is rolling out a free HAART programme to increase access and by 2009, 336980 patients were accessing , and adherence reported vary from 48% in Kibera, Nairobi ; 56.8% in Eldoret  and 64% in Mombasa .
The current study assessed non-adherence and factors associated with it in Nairobi, Kenya. Prevalence of non-adherence found in this study (18%) is comparable to the continental prevalence (23%) for Africa , 21% in Southwest Ethiopia  and 22% in Cote d’Ivore . But, inconsistent with the findings of Ellis et al. in Kibera, Nairobi (48%) ; Talam et al. in Eldoret (56.8%)  and Munyao et al. in Mombasa . The inconsistency with the findings of Eldoret study was attributed to differences in assessment methods, and inconsistency with the findings of Kibera and Mombasa studies to difference in treatment periods (2005) when ART knowledge among patients and clinicians was low .
Given the complex array of factors associated with non-adherence, no single strategy is likely to be effective for every patient. It is recommended that patients be targeted with comprehensive individualized interventions employing behavioral educational strategies to improve ability to fit therapy in own lifestyle and cue-dose training to impact forgetfulness. Further research is recommended to explain poor adherence among patients accessing therapy from ARV clinics within walking distance from their homes.
AOR: Adjusted Odds Ratio; ART: Antiretroviral Therapy; ARV: Antiretroviral; CCC: Comprehensive Care Centre; COR: Crude Odds Ratio; HAART: Highly Active Antiretroviral Therapy; HIV: Human Immunodeficiency Virus; OR: Odds Ratio.
The authors declare that they have no competing interests.
SNW conceived, designed and conducted study, analysed data and interpreted findings. ZWN and GGM supervised and guided the student. All authors contributed to the final report and approved the final manuscript.