The prevalence of established factors associated with adherence to Highly Active Antiretroviral Therapy (HAART) in non-adhering patients at the ARV clinic of Madzikane KaZulu Memorial Hospital
Thesis (MMed)--Stellenbosch University, 2015.
ENGLISH ABSTRACT: Background Adherence to HAART is key to any successful HAART programme. In Madzikane KaZulu Memorial Hospital ARV Clinic, there is an increasing number of patients on HAART and an increasing number of patients still awaiting HAART initiation. With the paucity of healthcare personnel in this rural district hospital, suboptimal patient’s preparation for HAART often occurs, and the HAART defaulter rate is on the increase. This is may be attributed to an interplay of factors affecting HAART adherence. Aim and Objectives The aim of this research was to determine the prevalence of established factors associated with adherence to Highly Active Antiretroviral Therapy (HAART) in non-adhering patients at the Madzikane KaZulu Memorial Hospital (MKMH) ARV clinic. The objectives were: • To conduct an audit on all case files of patients on HAART over the study period. • To explore the behavioural aspects of poor HAART adherence in a focused group discussion. • To describe the factors associated with good HAART adherence Methods Study design: A cross-sectional descriptive study which focused on determining the prevalence of established factors( patient-related, therapy-related and facility-related factors) affecting HAART adherence at the ARV clinic was carried out among identified HAART non-adhering patients. Patients that were not adhering with HAART between the period of January 2009 and December 2010 were selected for the study. These patients were 19 years or more and had been on HAART for at least two months. The study was carried out between November and December 2010. The result of the focused group discussion was utilized to refine the development of the questionnaire. Setting: The study was conducted at the Madzikane KaZulu Memorial Hospital ARV clinic. This is a modern 269 bed district hospital in the Mount Frere, Alfred Nzo district, Eastern Cape Province of South Africa. This is a predominantly rural region. Results: Data for analysis was provided by 215 patients that fulfilled the inclusion criteria. The prevalence rate of the factors affecting HAART adherence at the hospitals ARV clinic was 24%. A total of 60% of the patients were females. Majority of the patients (86.1%) had treatment supporters, and more than half of the patients (57.2%) were unemployed and not on disability grant. A total of 62.8% of the patients prefer to take their ARV at a clinic near them, and the majority of these patients (96.3%) want to start taking their ARV in a nearby clinic within 6months. The female gender, unemployment not on disability grant, longer period on HAART, Regimen 1A ARV( stavudine or tenofovir plus lamivudine and efavirenz according to the National ART guideline 2004 and its modified version of April 2010) single marital status and probably poorly selected unprepared treatment supporters, are associated with poor HAART adherence at this ARV clinic. Conclusion The study revealed that the prevalence rate of the factors affecting HAART adherence at the Madzikane KaZulu Hospital ARV clinic was 24% amongst HAART non-adhering patients. These patients had the prevalence rate of patient-related factors (12.4%) more than double of the prevalence rates of therapy related factors (5.8%), and facility related factors (5.7%). Topmost amongst the associated factors for not adhering to HAART were: not belonging to a support group, the pills making the patient feel unwell, and the ARV clinic being too far from where the patients live. Efforts should be targeted at enrolling the patients in support groups, encouraging the use of HAART regimens that have good tolerability profiles, and establishing the down referral.