Reasons for poor adherence to Antiretroviral Therapy (ART) by young female (15 -24 years) HIV/AIDS patients in Oshakati district

[摘要] ENGLISH ABSTRACT: Namibia has a small population of about 2 million people and its HIV/AIDS situation is notdifferent from that of the global trend. Approximately 20% of the sexually active adultpopulation lives with the virus (MoHSS, 2008). Studies carried out in Namibia in 2008 showsthat 6o% of the female were infected with HIV meaning the other 40% accounted for the rest ofthe population involving men and children (MoHSS,2008). This became a cause for concern tostimulate a research in this category of subjects. In Namibia, the national sentinel prevalencewas 18.8% among HIV pregnant women between ages 15- 49years. And Oshakati was the thirdhighest HIV/AIDS prevalence district in the country with 25.1% and this is higher than thenational average.(MoHSS, 2010:12).This stimulated interest for this study in Oshakati district inNamibia.Study objective of the Research: The objective was to establish the reason for poor adherenceamongst female-HIV/AIDS patients, 15-24 years of age, currently taking their medications fromOshakati Hospital‟s ARV Clinic in order to recommend good guidelines that will help toimprove adherence practices.Methods: A quantitative cross-sectional survey method was used to collect data from thesubjects. The tool used was questionnaires with predetermined set of questions having a set ofanswer options on socio-demographic, socio-economic information/level of education, religiousbelief /alcohol history, food and nutrition security, knowledge on antiretroviral therapy (ARV)drugs, practice of health care providers and patients on ART, treatment regimen/co-managementand social-cultural factors, to access adherence practices. The researcher worked with acommunity counselor at the Oshakati ART clinic. She was responsible for pre and postadherence counseling of the patients before the data collection exercise.Results: A total of 60 patients were used for the survey. The quantitative data analysis usingpatient self report adherence methods gave the following: Two-weeks recall 98%,oneweek78.33% and four days 68.33%. The mean adherence rates was estimated to be88%.Reasons cited for missing medication were unemployment 23%, long waiting time 52%,forgetfulness 52%,felt better 20%,too ill/felt worse 15%, side effects and two many pills 3% for TB patients on ART, problem with hospital staff 8%, stock-out 7%,avoiding friends /relativesbecause of their illness 27%. Alcohol abuse was not reported in this survey as adherence problemand was no report of ARV stocks out from Central Medical Stores during the study(MoHSS,2014).Recommendations:A functional ART committee currently lacking at this unit is recommended.Home base care services, follow up print out,community-based approaches, which involvestraining community health workers to supervise ART in patient‟s homes is highly recommended.The use of practical reminders should be communicated to the patients during adherencecounseling. Furthermore, means of transportation should be provided for them, like providingbus to convey the patients from a central location close to their homes to bring them to thehospital and take them back home.Conclusions :A lot of efforts is required to improve adherence. The constraints of adherencefound in this study should be addressed and more efforts to improve on the strength of the keyfacilitators of adherence. The governments, non government organizations, the commercialsector, needs to work together in a multi-sectoral dimension, involving the patient, thecommunity, health care workers and policymakers in collaboration with the hospitalmanagement committees to address this adherence issues to make a big difference.

[发布机构] Stellenbosch University