Factors associated with poor adherence amongst patients receiving antiretroviral therapy at the intermediate hospital Oshakati in Namibia
Year: 2011
Type: article
Abstract: Namibia is severely affected by the HIV/AIDS epidemic, with an estimated HIV prevalence of 17.8%.A comprehensive, public HIV/AIDS treatment and care programme was established in 2003 by the government of Namibia in association with its development partners.The introduction of antiretroviral therapy [ART] has dramatically decreased HIVrelated mortality and morbidity, improved quality of life, revitalized communities and transformed perceptions of HIV/AIDS from a plaque and death sentence to a manageable chronic condition.Intermediate Hospital Oshakati (IHO) in the Oshana region, is one of the six pilot hospitals where highly antiretroviral therapy (HAART) was initiated.Adherence to antiretroviral therapy (ART) is a key factor in ensuring optimal clinical outcomes and is associated with improved survival among HIV and AIDS patients.Sustained high levels of adherence (taking 95% or more of medication as prescribed) are essential for treatment success.Suboptimal adherence to treatment has been associated with virologic, immunologic and clinical failure, and may increase the risk of resistance to first-line ART drugs.Studies conducted in various parts of the country including the Oshakati district, report small proportions of patients defaulting on ART.Defaulting from treatment raises questions about adherence to ART as it can be assumed that poor adherence would precede defaulting from treatment.This study explored factors that influence poor adherence to ART among patients at Intermediate Hospital Oshakati. MethodologyAn explorative, qualitative study was conducted.In-depth interviews were conducted with 12 patients from the Communicable Disease Clinic (CDC) at Intermediate Hospital Oshakati who were identified as poor adherents.This data was triangulated with four key-informant interviews with health-workers in the facility.Data were audio-tape recorded and transcribed verbatim.Thematic and content analysis was done. ResultsThe reasons given by the participants for defaulting on their treatment included social factors such as spiritual beliefs, cultural beliefs, stigma and discrimination contributed patients first seek traditional healers' opinions before consulting health-worker, non-disclosure of HIV status and unwillingness to take medication in the presence of others.Patient related factors such as poor understanding of treatment regimen, forgetfulness, alcohol use, lack of v commitment, travelling and illiteracy affected the level of adherence to ART adherence.The health service related factors such as poor patient-health provider relationship, negative attitudes of health providers and long distance to health facility were reported to have influenced non adherence.Unemployment and unavailability of transport were major socio-economic factors that led to defaulting.In addition the findings of the study show work related factors such as work related pressure, together with lack of employers support, as well as treatment related factors, such as treatment side-effects and treatment fatigue, to have contributed to defaulting. ConclusionsPeople living with HIV/AIDS are still facing major social challenges such as stigma and discrimination by family members and the community as well as at work, and these hamper adherence.Illiteracy contributes to poor understanding about the importance treatment adherence leading to non-adherence.Therefore in order to improve adherence in communities a lot of effort needs to be put on literacy to enable patients have a better understanding about treatment adherence.vi
Author: Maria Francineth Bauleth
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W144095198