Abstract
Background: South African government and civil society has made a notable progress towards expanding access to anti-retroviral treatment (ART). However, there is a notable gap towards achieving satisfactory anti-retroviral treatment adherence rate of 95%-100%. The results of studies on the factors that are associated with ART treatment non-adherence in South Africa are inconsistent.
Objective: The goal of this study was to examine the factors associated with ARV therapy non-adherence amongst HIV-Patients at Helen Joseph Hospital in Gauteng Province of South Africa.
Methods: A case-control study design was used for the study. A total of (n=322) questionnaires survey was administered to research participants during their clinic visit. Data was also obtained from the clinic records and from the participants. The data analysis was conducted using EPI INFO version 7.2 and SPSS version 26. The research findings were presented examining adherence to ART therapy by demographic characteristics, medical and diagnosed factors, health system factors, patient related factors, psychosocial factors of the study participants.
Results: Participants with matric level of education were significantly less likely to be non-adherent, odds ratios (OR)= 0.50, 95% CI: (0.26-0.94) as compared to Bachelor’s degree. Compared to those employed, participants who were unable to work and those who were students, were less likely to be non-adherent OR= 0.35, 95% CI: (0.16-0.75) and OR= 0.06, 95% CI: (0.01-0.44), respectively. Participants who were diagnosed 1 year before first HIV diagnosis were less likely to be non-adherent adjusted odds ratios (AOR) = 0.34, 95% CI: (0.12-0.96), p-value 0.04 and AOR= 0.06, 95% CI: (0.02-0.19), respectively; and those diagnosed 6 and more years OR =0.10, 95% CI: (0.04-0.20). Using DTG /FTC/TDF as reference group participants on EFV/FTC/TDF regiment were less likely to be non-adherent AOR= 0.02 95% CI (0.01-0.06), p-value 0.001, on TDF/3TC/ LPV/r OR= 0.04 95% CI: (0.02 – 0.09) and on ABC/3TC/LPV/r OR= 0.01 95% CI: (0.01 – 0.08). Participants who responded sometimes to “Missed doses in the last 30 days”; “about half of the time” and “most of the time”, were more likely to be non-adherent OR= 10.14 95% CI: (1.00 -171.14); OR= 16.19 95% CI: (8.08 -32.44); and OR= 7.38 95% CI: (3.58 -15.22), respectively.
4
Compared to “Never” as a response, participants who responded sometimes on “having medication side effects” were less likely to be non-adherence AOR= 0.37 95% CI: (0.16 – 0.85), p-value 0.003; while those responding often were more likely to be non- adherent, AOR= 4.03 95% CI: (1.61-10.68), p-value 0.003. Participants who responded sometimes to having to “take many pills” were more likely to be non-adherent OR=2.25 95% CI: (1.26-4.02). Participants who responded rarely to “running out of pills” were less likely to be non-adherent AOR=0.27 95% CI: (0.09- 0.79) p-value 0.02; and sometimes AOR= 0.26 95% CI: (0.11-0.63,). p-value 0.001. Participants who responded rarely to “lack of access to clinic” were more likely to be non-adherent OR= 1.93 95% CI: (1.10- 3.38). Participants who responded, rarely, sometimes and often to “Long waiting times at the clinic” were more likely to be non-adherent AOR = 4.78, 95% CI: (1.12 -20.42), p-value 0.04; OR= 1.84 95% CI: (1.12- 3.02), and OR= 4.10 95% CI: (1.10- 15.62), respectively. Participants who responded rarely and sometimes to “Ill treatment from clinic staff” as cause of non-adherence to ARV therapy, were less likely to be non-adherent OR= 0.19 95% CI: (0.09-0.42), and OR= 0.01 (95% CI:0.01-0.04), respectively. In terms of “being away from home”, the participants who responded sometimes OR= 0.34 95% CI: (0.20-0.56) and often OR= 0.10 95% CI: (0.01-0.40) were less likely to be non- adherent. Participants who responded rarely to “Busy with other things:” were less likely non-adherent AOR= 0.11 95% CI: (0.04-0.30), p-value 0.001, but sometimes were more likely to be non-adherent AOR= 2.10 95% CI: (1.30-3.39), p-value 0.003. Participants who responded sometimes to “simply forgot” as reason for being non-adherent were less likely to be non-adherent AOR= 0.07 CI: (0.03-0.16), p-value 0.001; but those who responded rarely were more likely to be non-adherent AOR= 29.78 95% CI: (12.00-73.91), p-value 0.001.
Participants who responded rarely, sometimes and often to “Did not want others to notice you taking ART” were less likely to be non-adherent OR= 0.02 95% CI: (0.01 -0 12); OR= 0.20 95% CI: (0.10 -0 41); and OR= 0.01 95% CI: (0.01 -0 08), respectively. Participants who responded sometimes to “Felt like the drug was harmful”: were more likely to be non-adherent AOR= 4.34 95% CI: (1.69-11.14), p-value 0.002. and often AOR= 3.20 95% CI: (1.29-7.93), p-value 0.01. Participants who responded sometimes for “Asleep/slept through the dose-time”, were more likely to be non-adherent AOR= 1.50 (95% CI: 1.23-1.90) p-value 0.1, and often, OR= 6.38 95% CI: (2.72-14.92). Participants who responded rarely to “Felt sick or ill” where more likely to be no-adherent OR=8.06 95% CI (3.66-17.76), and sometimes OR= 2.35 95% CI 1.40-3.96), while often were AOR= 3.56 95% CI: (1.28-9.95), p- value: 0.02. Participants
5
who responded rarely to “Felt depressed or overwhelmed” were more likely to be non-adherent OR= 3.41 95% CI: (1.82-6.34), sometimes AOR= 4.63 95% CI (1.64-13.03), p- value 0.004; and often OR= 3.83 95% CI: (1.74-8.46). Participants who responded rarely to “Had problems taking pills at specified time”, were less likely to be adherent AOR= 0.27 95% CI: (0.11-0.65), p-value=0.004; and sometimes OR= 0.21 95% CI: (0.11-0.42). In terms of “the overall support from family” participants who responded rarely, were less likely to be non-adherent OR=0.16 95% CI: (0.08-0.33); sometimes AOR 0.07 95% CI: (0.02-0.03), p = 0.01, and often OR=0.08 95% CI:0.04 – 0.20). Participants who responded sometimes to “To what extent do your family members help you remember to take your medication”, were more likely to be non-adherent AOR= 2.09 95% CI: (1.04-4.20), p = 0.004, and often OR=3.62 95% CI: (2.13-6.15).
Conclusions: The result of this study indicate that ARV treatment non-adherence was higher among cases when compared to controls. The factors associated with ARV treatment non-adherence were identified. Public health Practitioners and Managers are encouraged to incorporate major contributing factors when developing quality improvement plan or strategies to improve ARV treatment adherence programme.
Keywords: ART therapy, Adherence to ART therapy, non-adherence to ART therapy, Treatment Defaulter; HIV patients, 90-90-90 HIV cascade.