Adherence of HIV/AIDS patients to antiretroviral therapy in a district hospital in Nankudu, Namibia
Thesis (MFamMed)--Stellenbosch University, 2014.
ENGLISH SUMMARY : Background: Non-adherence to highly active antiretroviral therapy (HAART) is a strong predictor of progression to AIDS and death. It remains the most important potentially alterable factor that determines treatment outcome. AIM: The main purpose of this study is to determine the current frequency of adherence to HAART in a major HIV/AIDS treatment center in Nankudu District and to identify the local factors contributing to non-adherence. OBJECTIVES: To assess and measure the adherence to antiretroviral therapy. To assess and describe the defaulter rate To assess and describe the interruption rate To describe the local barriers to sub-optimal adherence in the sample patients Methods: The study was a descriptive survey of the below mentioned three methods used to assess adherence to HAART and the determination of local barriers to adherence. The three methods used to measure HAART adherence were: pill counts, pharmacy refill data and self-report. The participants CD4 counts and viral loads were also evaluated. It included a randomly selected sample of 225 adult patients receiving HAART treatment in the Communication for Disease Control (CDC)-HIV clinic of Nankudu district hospital of Namibia. Results: A total of 90% of the patients had an adherence >95% comparable to those reported in most sub-Saharan Africa. The major local barriers to adherence included: distance from clinic (100%), lack of food (100%), lack of money (100%), poverty (100%), occupational factors-migration (100%), travel (81%), ran out of medicine (69%), too busy (69%), medication side effects (56%), felt better ( 56%) and too sick (50%). The major reasons given by the treatment defaulters were similar to those given by the treatment interrupters except for stigma (100%), compared to 19% for the treatment interrupter. Conclusion: The level of HAART adherence in the Communication Diseases Control (CDC)- HIV Clinic, of Nankudu District Hospital in Namibia is comparable to those reported in most sub-Saharan Africa, which is the recommended 95%. The pattern of non-adherence is characterized by treatment defaulters and interrupters. The study revealed that there were more treatment interrupters than defaulters. Financial constraints, travel, running out of ARV medicine, food insecurity, poverty, distance from the clinic, were the major reasons given by the treatment interrupters, while occupational factors, lack of transport, stigma, and long distance of the health facility were the major reasons given by the treatment defaulters.
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