Measurement of and factors affecting patients' adherence to anti-retroviral therapy in Helen Joseph Hospital, Johannesburg

[摘要] Introduction: A study of adherence was conducted at the HIV Clinic of Helen JosephHospital, Johannesburg between June and September 2004. First it measured the level ofadherence of patients (referred to as participants in this report) to antiretroviral medications.The relationship between adherence results and the viral load of the participants wasexplored. Factors such as treatment regimens, patient-provider relationship, patients’knowledge of HIV treatment, disclosure of HIV status and support for HIV positiveindividuals 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 thestudy, representing 92.9% response rate. Participants were interviewed using a questionnaireand their HIV RNA concentrations (viral loads) ascertained. Adherence was defined as >=95% (higher adherence) if a participant missed 0-2 medication doses and < 95% (loweradherence) 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 for0.5% (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 hadundetectable HIV RNA concentrations (i.e. viral load <50 copies/ml) and 64 had detectableviral load. Among the higher adherence category of participants 67.7% (113/167) hadundetectable 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 of2.90 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 wasv7.2 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 withlower adherence of achieving undetectable plasma HIV RNA (OR = 6.98; p = 0.004).Inadequate knowledge about HIV treatment where participants never heard of treatmentadherence (p = 0.001), viral load (p = 0.001), or Cd4 cell count (p < 0.001); whereparticipants believed that drugs cure HIV (p = 0.026), that one can stop treatment if one feelsbetter (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 weredietary 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 tobe reported where provider could speak patients’ preferred language (p = 0.035), assistpatients with treatment difficulties (p = 0.002) and where provider was seen to be not toobusy to listen to patients (p = 0.044). The method by which patients received informationabout HIV and its treatment did not affect reported adherence levels (p = 0.805). Disclosureof HIV status to both partner and family member (p < 0.001), and receiving social supportfrom family members (p = 0.007) were found to be associated with reported higheradherence. 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 toantiretroviral medications.Conclusion: This study suggests that the HIV-positive patients in the HIV clinic of HelenJoseph Hospital can maintain a high level of adherence to regimen of antiretroviraltreatment. However, there is a need to develop strategies to enhance educationalviprogrammes and strengthen knowledge of HIV treatment among lower adherence categoryof patients, and to improve patients’ self-management and care for mediation pills. Furtherresearch is recommended to assess broader psychosocial factors predicting adherence in thispopulation, and to ascertain what really happens to ARV pills dispensed to patients.

[发布机构] University of the Witwatersrand