Factors Influencing Adherence to Antiretroviral Treatment in Nepal: A Mixed-Methods Study.

Wasti, S. P., Simkhada, P., Randall, J., Freeman, J. and van Teijlingen, E., 2012. Factors Influencing Adherence to Antiretroviral Treatment in Nepal: A Mixed-Methods Study. PLoS One, 7 (5), e35547.

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Official URL: http://www.plosone.org/article/info%3Adoi%2F10.137...

DOI: 10.1371/journal.pone.0035547

Abstract

Background Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. Methods A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. Results A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014); alcohol use (OR = 12.89, p = <0.001), being female (OR = 6.91, p = 0.001), being illiterate (OR = 4.58, p = 0.015), side-effects (OR = 6.04, p = 0.025), ART started ≤24 months (OR = 3.18, p = 0.009), travel time to hospital >1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. Conclusion Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients’ lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients.

Item Type:Article
ISSN:1932-6203
Uncontrolled Keywords:AIDS, HIV, compliance, South Asia, adherence, antiretroviral
Subjects:Technology > Medicine and Health
Social Sciences > Sociology
Group:School of Health and Social Care
ID Code:20021
Deposited By:Prof Edwin van Teijlingen
Deposited On:05 May 2012 16:28
Last Modified:08 Jan 2013 16:08

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