Factors Affecting Adherence to Co-Trimoxazole Preventive Therapy in HIV/AIDS Patients Attending an Antiretroviral Therapy Clinic in Ethiopia University Hospital: A Cross-Sectional Study (original) (raw)
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Patient adherence to antiretroviral combination therapy is a critical component to successful treatment outcome. Nonadherence to antiretroviral therapy (ART) is a major challenge to AIDS care, and the risks associated with it are extensive. The intention of this study was to determine prevalence and associated factors with adherence to highly active ART among people living with HIV/AIDS (PLWHA) at the Debrebrihan Referral Hospital and Health Center, Northeast Ethiopia. A cross-sectional study design with systematic random sampling conducted by the use of a structured, pretested self-rating adherence questionnaire was used to conduct the study among 422 respondents from the Debrebrihan Referral Hospital and Health Center. A single population proportion formula at 95% CI with 5% of marginal error at 50% of prevalence of occurrence was used to determine sample size. Adherence was defined as not missing a single ART dose during the 30-day period prior to filling out the self-report. Adherence was measured by self-reports by the patients. These results were then used in binary logistic regression analysis. Covariates were analyzed by bivariate and multivariate logistic regression with SPSS statistical software. The total number of respondents in this study was 422; their median age was 35 years. Among the participants, 95.5% were taking their medication without missing a dose. Factors such as having emotional or practical support positively encouraged ART adherence (adjusted odds ratio 0.16 [95% CI 0.05–0.49]). However, users of traditional, complementary, and alternative medicine (TCAM) (adjusted odds ratio 4.7 [95% CI 1.06–21.22]) had nearly a five times higher risk for ART nonadherence (P,0.05) than those not using TCAM. Adherence to ART among PLWA is imperative and standard. But, there is still a need to boost psychological support and practical support for the clients, and there is also a need to create a more integrative approach with TCAM in order to increase adherence to ART. Strengthening emotional and practical support for PLWHA and integrating TCAM with the proper use of ART are mandatory to enhance ART adherence. Keywords: people living with HIV, adherence, holy water, traditional medicine, complementary
Journal of Tropical Diseases, 2014
Background: Adherence to ART is the primary determinant of viral suppression and the risk of transmission, disease progression and death. Adherence of at least 95% is needed for optimal suppression. This study aimed at determining the adherence to Anti-Retroviral Therapy (ART) and its associated factors among People Living with HIV and AIDS in ART Center of Chitwan, Nepal. Methods: A descriptive cross-sectional study was conducted among 231 clients aged 18 years to 49 years taking ART from Bharatpur Hospital of Chitwan and those who have been enrolled in ART for at least 6 months, were interviewed. Systematic Sampling technique was used. Semi-structured questionnaire was prepared by taking reference from the AIDS Clinical Trial group questionnaire (ACTG). Adherence was measured by patient self report. Data was entered Epi Data 3.1 and analyzed using Statistical Package for Social Sciences (SPSS) software where the P value of < 0.05 was accepted as being statistically significant. The independent variables which were found significant at p-value 0.10 in bivariate analysis were fitted in multivariable logistic regression model. Multivariable logistic regression model was performed to know the net effect of the independent variables on Adherence to ART medication. Results: The overall adherence in the last month was found to be 87.4%. Wrist watch and mobiles were seen as a facilitating factor for taking ART on time as clients taking ART used to set alarm to get informed of the medication time. Adherence was associated with female sex (AOR = 10.550 CI: 1.854-60.046), family consisting only parents and their children (AOR = 4.877, CI: 1.246-19.079), having no habit of taking alcohol (AOR = 5.842 CI: 1.294-26.383), HIV duration of more than 3 years (AOR = 10.055 CI: 2.383-42.430), picking up ART medications on their own (AOR = 7.861, CI: 1.670-36.998) and not having side effects of ART (AOR = 8.832, CI: 2.059-37.890). Conclusion: Identifying and evaluating the problems faced by ARV drug users can foster the achievement of ART related goals and addressing ART related problems in a rational way. Effective and appropriate monitoring of non adherence behaviors can help patients increase adherence level fostering improvement in treatment outcome.
Gaziantep Medical Journal, 2013
Adherence to anti-retroviral therapy (ART) regimen is essential for successful treatment and sustained viral control. Optimal adherence is the compliance to ART that achieves a sustained plasma drug concentration that suppresses viral replication. The objective of this study is to assess ART adherence and its determinants at Agaro Health Center ART Clinic, South Western Ethiopia. Facility-based cross sectional study was conducted from June 9-29, 2011. Patients were interviewed to collect adherence related information by using pretested semi-structured questionnaire. Subsequent charts of prescribed medications were reviewed using a pretested data collection format. A total of 209 respondents were included in the study, of which 127 (60.8%) were females and 82 (39.2%) were males. The average adherence rate was 98.1% among males and 99.5% among females. The overall average adherence rate among the respondents was 98.8%. One hundred sixty one (77.0%) respondents had a 100% adherence rate, 15 (7.2%) patients had a 93.3% adherence rate and the remaining 33 (15.8%) patients had adherence rate between 95 and 98% on average. The common reasons for missing of the prescribed doses were forgetting 27 (39.7%), being too busy 20 (29.4%), away from home 17 (25.0%) and being extremely ill 4 (5.9%). Of all the variables, sex, living alone, monthly income, use of stimulants and medications in addition to ART were significantly associated with non-adherence. The adherence rate among the study participants was found to be optimal, and near perfect adherence need to be maintained to obtain the optimum therapeutic outcome.
INTERNATIONAL RESEARCH JOURNAL OF PHARMACY, 2014
Co-trimoxazole is used as preventing therapy for many opportunistic infections in people living with HIV/AIDS. The main purpose of this study was to evaluate co-trimoxazole as preventive therapy in Jimma health center. A retrospective Cross-sectional method was used and data was collected from June 28 to July 08 2013. Form the total 320 patients, 185 (57.8 %) were females, 142 (98.4 %) were in the child bearing age. Most (90.3 %) of the patients were world health organization clinical stage I. There were not any cases in which co-timoxazole was used against contraindication; co-trimoxazole was used as per the recommended prophylactic dosage in 320 (100 %) of the patients. The treatment was discontinued in 11 patients, eight (2.5 %) of the discontinuations were due to CD4 + count greater than 350 cell/mm 3. Co-trimoxazole preventive therapy was started prior to antiretroviral therapy in 260 (81.3 %), concurrently with Antiretroviral Therapy in 46 (14.4 %) and after Antiretroviral Therapy in 1 (0.3 %) of the patients. Only 29 (9.06 %) patients were monitored regularly and monitoring schedule or data was not recorded for 122 (38.13 %) patients. The evaluation of Co-trimoxazole as preventive therapy among people living with HIV/AIDS was in line with the WHO guideline for indication in all of the patients'. Dosage and observance of contraindication was also consistent with the guideline in most of the cases studied. Problems regarding patient monitoring and initiations of CPT relative to ART were identified in most of the patients.
2015
Background: Ethiopia is one of the Sub-Saharan Africa countries highly affected by HIV epidemics. Antiretroviral therapy (ART) alters and reduces progression to AIDS and prolongs and improves the quality of life among HIV infected population. For ART, at least 95% adherence is required to prevent the development of drug resistant viral strains. Non-adherence to ART may result in regimen failure, immune suppression and emergence of resistant viral strains, limited future treatment options, and higher treatment costs. Objective: The aim of this study is to assess factors influencing ART adherence among PLWHA on ART treatment in JUTH ART clinic. Method: A cross-sectional study was conducted on a sample of 221 PLWHA who had follow-up at JUTH ART clinic from February to March 2015. Data was collected through interview using structured questionnaire by graduating nursing students. Data was cleared and checked for completeness and compiled on excel sheet for analysis. Chi-square test was c...
Background: Ethiopia is one of the Sub-Saharan Africa countries highly affected by HIV epidemics. Antiretroviral therapy (ART) alters and reduces progression to AIDS and prolongs and improves the quality of life among HIV infected population. For ART, at least 95% adherence is required to prevent the development of drug resistant viral strains. Non-adherence to ART may result in regimen failure, immune suppression and emergence of resistant viral strains, limited future treatment options, and higher treatment costs. Objective: The aim of this study is to assess factors influencing ART adherence among PLWHA on ART treatment in JUTH ART clinic. Method: A cross-sectional study was conducted on a sample of 221 PLWHA who had follow-up at JUTH ART clinic from February to March 2015. Data was collected through interview using structured questionnaire by graduating nursing students. Data was cleared and checked for completeness and compiled on excel sheet for analysis. Chi-square test was calculated at 5% level of significance to see the association between independent and dependent variables and p-value of <0.05 was considered statistically significant. Finally the result was presented in text statement, figure and tables. Results: Of the total 221 participants more than half 153 (69%) were greater than 30 years, 144 (65.15%) were females, 167 (75.56%) were urban dwellers, 169 (76.43%) were Oromo ethnic group. Overall from the study participants 80 (36.19%) had poor adherence and 141 (63.8%) had good adherence to their ART treatment. Factors like educational status, residence, occupation and alcohol addiction are significantly associated with the level of adherence to ART treatment. Conclusion and recommendation: Although the prevalence of HIV/AIDS is reducing adherence remains as one of the challenges the control of HIV/AIDS where only around 2/3rd of PLWHA were well adhered to ART. Based on the finding of this study, JUTH should counsel patients about advantage of taking ART drugs properly, risk of not taking the medicines appropriately, the method how to remember the time of taking drugs and other factors that influence ART adherence.
HIV/AIDS - Research and Palliative Care, 2020
BackgroundFor people living with HIV, to have sustainable viral suppression and better clinical outcomes, they should have a high level of adherence to antiretroviral therapy. In the treatment of human immune deficiency, antiretroviral therapy adherence became the major challenge in both developed and developing countries. The level of antiretroviral therapy differs across the settings. This study aimed to assess the level of combined ART adherence and associated factors among adult people living with HIV attending Nekemte Specialized Hospital, Ethiopia.MethodsThe institution-based cross-sectional quantitative study was conducted from August 2017 to September 2017. A total number of 284 clients participated in the study and a simple random sampling technique was used to allocate study participants. Data were entered into Excel and exported to SPSS version 20 for analysis. Bivariate analysis was conducted to identify candidate variables for multivariate analysis at p-value <0.2. Multiple logistic regression analysis was conducted to determine the predictors of non-adherence to ART. P-value <0.05 was considered to indicate statistical significance.ResultsAbout 81% of the study participants adhered to combined anti-retroviral therapy. Mentioned reasons for missing ART medications were simply forgot to take medication (44.4%), lack of transportation (21%), to avoid side effects (11.4%), do not want significant others to notice taking medication (11.4%) and felt sick (11.4%). Not using reminder (AOR=4.98 (1.65, 15.02)), poor knowledge on ART (AOR=2.79 (1.49, 5.25)), and engaging in unprotected sexual intercourse (AOR=2.16 (1.15, 4.05)) were significantly associated with non-adherence to combined ART.ConclusionAbout 81% of study participants adhered to combined ART, and poor knowledge about ART, engaging in unprotected sexual intercourse and not using the reminder were significantly associated with nonadherence to combined ART. Efforts to increase adherence levels should be encouraged.
HIV/AIDS - Research and Palliative Care
Background: For people living with HIV, to have sustainable viral suppression and better clinical outcomes, they should have a high level of adherence to antiretroviral therapy. In the treatment of human immune deficiency, antiretroviral therapy adherence became the major challenge in both developed and developing countries. The level of antiretroviral therapy differs across the settings. This study aimed to assess the level of combined ARTadherence and associated factors among adult people living with HIV attending Nekemte Specialized Hospital, Ethiopia. Methods: The institution-based cross-sectional quantitative study was conducted from August 2017 to September 2017. A total number of 284 clients participated in the study and a simple random sampling technique was used to allocate study participants. Data were entered into Excel and exported to SPSS version 20 for analysis. Bivariate analysis was conducted to identify candidate variables for multivariate analysis at p-value <0.2. Multiple logistic regression analysis was conducted to determine the predictors of non-adherence to ART. P-value <0.05 was considered to indicate statistical significance. Results: About 81% of the study participants adhered to combined anti-retroviral therapy. Mentioned reasons for missing ART medications were simply forgot to take medication (44.4%), lack of transportation (21%), to avoid side effects (11.4%), do not want significant others to notice taking medication (11.4%) and felt sick (11.4%). Not using reminder (AOR=4.98 (1.65, 15.02)), poor knowledge on ART (AOR=2.79 (1.49, 5.25)), and engaging in unprotected sexual intercourse (AOR=2.16 (1.15, 4.05)) were significantly associated with non-adherence to combined ART. Conclusion: About 81% of study participants adhered to combined ART, and poor knowledge about ART, engaging in unprotected sexual intercourse and not using the reminder were significantly associated with nonadherence to combined ART. Efforts to increase adherence levels should be encouraged.
HIV and AIDS Review, 2016
Non-adherence to antiretroviral therapy (ART) is a powerful predictor of survival for individuals living with HIV/AIDS [1]. On the other hand, adherence to ART is critical for optimal virologic suppression and improved number of CD4+ cell [1,2]. The rate of non-adherence to ART remains high and key challenges to the programs in many countries of the world [3-7]. Patients were considered highly adherent if they reported taking !95.0% of their medication as prescribed [2]. In several studies, non-adherence of patients on ART was the strongest indicator of failure to achieve viral suppression below the level of detection [8]. It is also an important factor in treatment failure and development of drug resistance as well as progression to AIDS and death [1,2]. The measurement of adherence of patients to treatment has been a major challenge because of the subjective and private nature of pill taking behavior in ambulatory patients. These challenges are compounded by the fact that adherence is not only affected by patient behavior alone. The ideal adherence measurement tool should be non-invasive, simple to use, sensitive, specific, and predictive of non-adherence [7,8]. Currently, there is no adherence measurement tool with all of the above attributes. This has led the recommendation to use a multi-method approach (self report, visual analogue scale, and pill identification test and pill count) that combines feasible self-reporting and reasonable objective measures [8].
Clinical Medicine Research, 2015
Introduction: HIV/AIDS is one of the most destructive epidemics the world has ever witnessed. Non-adherence to the proposed antiretroviral regimen is considered to be one of the greatest dangers to the response to treatment on an individual level and the dissemination of resistant viruses on the community level. An adherent patient is defined as one who takes > 95% of the prescribed doses. Objective: To assess the level of adherence and associated factors among adult HIV/AIDS patients receiving Highly Active Antiretroviral Therapy in Mekelle Hospital, Northern Ethiopia. Methods: A cross sectional study was carried out from January 1, 2013 to July 30, 2013 among 382 adult PLWHA (>=18 years) attending HAART clinic at Mekelle Hospital. Data was collected by a combination of structured questionnaire and document review. The data was entered and cleaned using Epi-Info; transported to SPSS 16.0 version for final analysis. Bivariate and multivariate analyses were performed to identify factors associated with adherence. Results: The rate of self reported adherence in the study based on the Schedule and indicator of the dose, time measurement in the last 7 days was (78.3%). Females were more adhered than males (185(87.7%)). Alcohol users have poor adherence than non alcohol users with 70.5% and 82.2% level of adherence respectively. Sex and educational status of the study participants were significantly associated with level of adherence with AOR (95% CI) of 3.81(2.18, 6.69) and 2.60(1.43, 4.71) respectively. Conclusion: The level adherence we found, 78.2%, is still very low considering the WHO recommendation of 95%. Sex and educational status of the study participants were significantly associated with level of adherence with AOR (95% CI) of 3.81(2.18,6.69) and 2.60(1.43,4.71) respectively. More focus should be given to males and individuals with low educational status to improve level of adherence and to assure the efficacy of HAART in prolonging the life of PLWHA. Adherence is a process, not a single event, and adherence support must, therefore, be integrated into regular clinical follow up. Investigation of factors related with long-term adherence would require longer follow-up than the present study.