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Open Access 01-12-2015 | Research article

Strengthening adherence to Anti Retroviral Therapy (ART) monitoring and support: operation research to identify barriers and facilitators in Nepal

Authors: Kiran Bam, Rajesh M Rajbhandari, Dibesh B Karmacharya, Sameer M Dixit

Published in: BMC Health Services Research | Issue 1/2015

Abstract

Background

Anti Retroviral Therapy (ART) is the cornerstone for comprehensive health sector response to Human Immunodeficiency Virus (HIV) treatment, care and support. Adherence of at least 95% is needed to keep HIV under control, as per World Health Organization (WHO) guidelines. This study was aimed at identifying the overall adherence level of, and barriers and facilitators to adherence for patients taking ART in different clinics in all five development regions of Nepal.

Methods

A descriptive cross-sectional study was conducted among ART clients receiving free ART from Government of Nepal ART clinics. A total of 435 clients taking ART from twelve ART clinics in different regions of Nepal, aged fifteen years and above were interviewed on one-and-one basis using questionnaires developed in reference to Adult AIDS Clinical Trial Group (AACTG) toolkit among them data from 404 were analyzed after cleaning. Data was entered and analyzed using Statistical Package for Social Sciences (SPSS) software where the P value of < 0.05 was accepted as being statistically significant.

Results

The overall adherence in the last month (missed less than three pills total) was 94.8% (383 out of 404). The main barrier to ART adherence was the fear of side effects (among 61.9% of the non adherent population) which included dizziness (18.1%) and headaches (15.4%). The standard wristwatch (39%) was found to be the most useful aid in enabling timely consumption of medication. Educational status (P = 0.018), drug using habits (P = 0.039) and the conducive environment at ART clinics (P = 0.004) were significantly associated with ART adherence.

Conclusion

Improving better adherence may require a more holistic approach to treatment regimen and adapting it to patient daily routines. This study identifies issues such as pill count for assessing adherence, better access to health care facilities by clients, better access to medication, as well as improved nutritional support issues for better adherence by the population in the future.

UNAIDS. World AIDS Day Report; 2011. Available at: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/JC2216_WorldAIDSday_report_2011_en.pdf

WHO. Towards universal access: Scaling up priority HIV/AIDS interventions in the health sector; 2007. Available at: http://www.who.int/hiv/mediacentre/universal_access_progress_report_en.pdf

Mocroft A, Vella S, Benfield TL, Chiesi A, Miller V, Gargalianos P, et al. Changing patterns of mortality across Europe in patients infected with HIV. Lancet. 1998;3521:1725–30.CrossRef

NCASC. Cumulative HIV/AIDS situation of Nepal. Factsheet on HIV/AIDS Statistics, 2011. National Centre for AIDS and STD Control, Kathmandu. Available at: http://www.ncasc.gov.np/index1.php?option=information&id=36

NCASC. National Guidelines on Anti-Retroviral (ARV) Therapy. Kathmandu, Nepal: National Center for AIDS & STD Control; 2005.

Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. Adherence to protease inhibitor therapy and outcomes in clients with HIV infection. Ann Intern Med. 2000;133(1):21–30.CrossRefPubMed

García DOP, Knobel H, Carmona A, Guelar A, López-Colomés JL, Caylà JA. Impact of adherence and highly active antiretroviral therapy on survival in HIV-infected clients. J Acquired Immune Deficiency Syndromes. 2002;30(1):105.CrossRef

Carter M. Adherence – information series for HIV-positive people. 3rd ed. London: NAM; 2005 [http://www.aidsmap.com].

Paterson DL, Swindells S, Mohr J. How much adherence is enough? A prospective study of adherence to protease inhibitor therapy using MEMSCaps. In: 6th Conference on Retroviruses and Opportunistic Infections 1999, Chicago, USA. Abstract no. 92. 1999.

10.

Lwanga SK, Lesmeshow S. Sample size determination in health studies: a practical manual. Geneva: World Health Organization; 1991.

11.

Bam K, Karki DK, Lohani SP, Thapa R, Aryal UR, Pathak LR. Adherence to Anti-Retroviral Therapy among People Living with HIV and AIDS in Far West, Nepal. Asian J Med Sci. 2011;2(1):7–13.CrossRef

12.

Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B, et al. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. AIDS Care. 2002;12:255–66. doi: 10.1080/09540120050042891.CrossRef

13.

Shah B, Walshe L, Saple DG, Mehta SH, Ramnani JP, Kharkar RD, et al. Adherence to antiretroviral therapy and virologic suppression among HIV-infected persons receiving care in private clinic in Mumbai, India. Clin Inf Dis. 2007;44:1235–44.CrossRef

14.

Wang H, He G, Li X, Yang A, Chen X, Fennie KP, et al. Self-Reported adherence to antiretroviral treatment among HIV-infected people in Central China. AIDS Patient Care & STDs. 2008;22:71–80.CrossRef

15.

Li L, Lee SJ, Wen Y, Lin C, Wa D, Jiraphongsa C. Antiretroviral therapy adherence among clients living with HIV/AIDS in Thailand. Nurs Health Sci. 2010;12:212–20.CrossRefPubMedPubMedCentral

16.

Talam NC, Gatongi P, Rotich J, Kimaiyo S. Factors affecting antiretroviral drug adherence among HIV/AIDS adult clients attending HIV/AIDS clinic at Moi teaching and referral hospital, eldoret, Kenya. East African Journal of Public Health. 2010;5:74–8.

17.

Bhat VG, Ramburuth M, Singh M, Titi O, Antony AP, Chiya L, et al. Factors associated with poor adherence to anti-retroviral therapy in clients attending a rural health centre in South Africa. Eur J Clin Microbiol Infect Dis. 2008;29:947–53.CrossRef

18.

Holmes WC, Bilker WB, Wang H, Chapman J, Gross R. HIV/AIDS-specific quality of life and adherence to antiretroviral therapy over time. JAIDS J Acquired Immune Deficiency Syndromes. 2007;46(3):323–7.CrossRef

19.

Tadios Y, Davey G. Retroviral drug adherence & its correlates in Addis Ababa, Ethiopia. Ethiop Med J. 2006;44:237–44.PubMed

20.

Lyon ME, Trexler C, Akpan-Townsend C, Pao M, Selden K, Fletcher J, et al. A family group approach to increasing adherence to therapy in HIV-infected youths: results of a pilot project. AIDS patient care and STDs. 2003;17(6):299–308.CrossRefPubMed

21.

Hardon AP, Davey S, Gerrits T, Hodgkin C, Irunde HF, Kgatlwane J, et al. From access to adherence: The challenges of antiretroviral treatment: Studies from Botswana, Tanzania and Uganda. Geneva: World Health Organization; 2006.

22.

Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol Use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr. 2009;52:180–202.CrossRefPubMedPubMedCentral

23.

Sodergard B, Halvarsson M, Tully MP, Mindouri S, Nordstrom ML, Lindback S, et al. Adherence to treatment in Swedish HIV-infected patients. J Clin Pharm Ther. 2006;31:605–16.CrossRefPubMed

24.

Wang X, Wu Z. Factors associated with adherence to antiretroviral therapy among HIV/AIDS clients in rural China. AIDS. 2007;21:S149–55.CrossRefPubMed

25.

Safren SA, Kumarasamy N, James R, Raminani S, Solomon S, Mayer KH. ART adherence, demographic variables and CD4 outcome among HIV-positive clients on antiretroviral therapy in Chennai, India. AIDS care. 2005;17(7):853–62.CrossRefPubMed

26.

Chesney MA, Morin M, Sherr L. Adherence to HIVcombination therapy. Soc Sci Med. 2000;50:1599–605.CrossRefPubMed

27.

Ammassari A, Murri R, Pezzotti P, Trotta MP, Ravasio L, De Longis P, et al. Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV infection. JAIDS J Acquired Immune Deficiency Syndromes. 2001;28(5):445–9.CrossRef

28.

Markos E, Worku A, Davey G. Adherence to ART in PLWHA at Yirgalem Hospital, South Ethopia. Ethopia J Health Dev. 2008;22(2):174–9.

29.

Erah PO, Arute JE. Adherence of HIV/AIDS clients to antiretroviral therapy in a tertiary health facility in Benin City. Afr J Pharmacy Pharmacol. 2008;2:145–52.

30.

Tucker JS, Orlando M, Burnam MA, Sherbourne CD, Kung FY, Gifford AL. Psychosocial mediators of antiretroviral nonadherence in HIV-positive adults with substance use and mental health problems. Health Psychology. 2004;23(4):363.CrossRefPubMed

31.

Berg KM, Demas PA, Howard AA, Schoenbaum EE, Gourevitch MN, Arnsten JH. Gender differences in factors associated with adherence to antiretroviral therapy. J Gen Intern Med. 2004;19:1111–7.CrossRefPubMedPubMedCentral

Title: Strengthening adherence to Anti Retroviral Therapy (ART) monitoring and support: operation research to identify barriers and facilitators in Nepal
Authors: Kiran Bam
Rajesh M Rajbhandari
Dibesh B Karmacharya
Sameer M Dixit
Publication date: 01-12-2015
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2015
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-015-0846-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Strengthening adherence to Anti Retroviral Therapy (ART) monitoring and support: operation research to identify barriers and facilitators in Nepal

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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