Reasons for poor adherence to Antiretroviral Therapy (ART) by young female (15 -24 years) HIV/AIDS patients in Oshakati district
Thesis (MPhil)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Namibia has a small population of about 2 million people and its HIV/AIDS situation is not different from that of the global trend. Approximately 20% of the sexually active adult population lives with the virus (MoHSS, 2008). Studies carried out in Namibia in 2008 shows that 6o% of the female were infected with HIV meaning the other 40% accounted for the rest of the population involving men and children (MoHSS,2008). This became a cause for concern to stimulate a research in this category of subjects. In Namibia, the national sentinel prevalence was 18.8% among HIV pregnant women between ages 15- 49years. And Oshakati was the third highest HIV/AIDS prevalence district in the country with 25.1% and this is higher than the national average.(MoHSS, 2010:12).This stimulated interest for this study in Oshakati district in Namibia. Study objective of the Research: The objective was to establish the reason for poor adherence amongst female-HIV/AIDS patients, 15-24 years of age, currently taking their medications from Oshakati Hospital‟s ARV Clinic in order to recommend good guidelines that will help to improve adherence practices. Methods: A quantitative cross-sectional survey method was used to collect data from the subjects. The tool used was questionnaires with predetermined set of questions having a set of answer options on socio-demographic, socio-economic information/level of education, religious belief /alcohol history, food and nutrition security, knowledge on antiretroviral therapy (ARV) drugs, practice of health care providers and patients on ART, treatment regimen/co-management and social-cultural factors, to access adherence practices. The researcher worked with a community counselor at the Oshakati ART clinic. She was responsible for pre and post adherence counseling of the patients before the data collection exercise. Results: A total of 60 patients were used for the survey. The quantitative data analysis using patient 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 be 88%.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 /relatives because of their illness 27%. Alcohol abuse was not reported in this survey as adherence problem and 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 involves training 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 adherence counseling. Furthermore, means of transportation should be provided for them, like providing bus to convey the patients from a central location close to their homes to bring them to the hospital and take them back home. Conclusions :A lot of efforts is required to improve adherence. The constraints of adherence found in this study should be addressed and more efforts to improve on the strength of the key facilitators of adherence. The governments, non government organizations, the commercial sector, needs to work together in a multi-sectoral dimension, involving the patient, the community, health care workers and policymakers in collaboration with the hospital management committees to address this adherence issues to make a big difference.
AFRIKAANSE OPSOMMING: Namibië is 'n klein landjie met 'n bevolking van ongeveer 2 miljoen mense. Die gevolge van die MIV/Vigs-pandemie is egter vir hierdie land dieselfde as vir enige ander land. Studies wat in Namibië gedoen is dui daarop dat die voorkoms van MIV/Vigs in Namibië baie hoog is, met Oshakati die distrik met die hoogste voorkoms in die hele Namibië. Die doel van die studie was om te probeer vasstel waarom vroulike MIV-pasiënte nie getrou hulle medikasie gebruik nie. 'n Verdere doelwit was om riglyne vir die antiretrovirale eenheid van die Oshakati hopitaal te ontwikkel ten einde te verseker dat pasiënte hou by die voorgeskrewe gebruik van die medikasie wat hulle ontvang. Ten einde die navorsing uit te voer is 'n vraelys gebruik by 'n steekproef van 60 pasiënte in die Oshikati hospitaal in Namibië. Redes wat vir die ongereelde gebruik van medikasie aangevoer is was onder andere werkloosheid, lang waglyste by die hospitaal, blote vergeet om medikasie te gebruik, pasiënte voel beter en los dan die medikasie, newe-effekte en alkohol misbruik. Voorstelle word aan die einde van die studie gemaak vir die verbetering van die bogenoemde situasie. Die daarstelling van 'n funksionele antiretovirale komitee word voorsgestel en ander praktiese oorwegings ( soos om byvoorbeeld boodskappe aan pasiënte te stuur) word aan die hand gedoen. Daar word ook 'n sterk motivering uitgemaak vir die beter opleiding vir gemeenskapswerkers wat direk met MIV/Vigs pasiënte werk.