Highly active antiretroviral therapy adherence and its determinants in selected hospitals from SNNPR and Oromia regional states, Ethiopia

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dc.contributor.advisor Engidawork, E en
dc.contributor.advisor Gebre-Mariam, T en
dc.contributor.advisor Gedif, T en
dc.contributor.author Beyene, Kebede en
dc.date.accessioned 2018-10-09T23:06:41Z en
dc.date.issued 2008-03-21 en
dc.date.submitted 2008-01-31 en
dc.identifier.uri http://hdl.handle.net/2292/40146 en
dc.description.abstract Background: HAART has greatly reduced the morbidity and mortality associated with HIV-1 infection. The long-term success of HAART is dependent on a high level of adherence to the regimen prescribed. The unforgiving nature of the virus requires that levels of adherence be higher and more sustained than in most other areas of medicine. Furthermore, poor adherence to ARV medications speeds up development of drug resistant HIV. Consequently, drug resistance limits the choices for HIV treatment. Improved QOL has been recognized as an important outcome from the treatment of HIV. HAART adherence is known to contribute to improved HIV clinical outcomes, which could result in a better QOL. Objective: To determine the current adherence rate and its determinants among PLWHA and on HAART and to assess QOL of patients on HAART in selected governmental hospitals of SNNPR and Oromia regional states, Ethiopia. Methodology: A cross-sectional study that involved qualitative and quantitative methods was conducted between August and October 2007 in Yirgalem, Hawassa and Shashemene Hospitals. Quantitative data collection techniques include patient self-report and unannounced pill count and the qualitative methods employed were focus group discussions, semi-structured interviews and observations of health facilities. Short form-36 health survey instrument was used to collect data on QOL of PLWHA and on HAART. Results: The participants were 238 (56.4%) females and 184 (43.6%) males. Out of the total, 393 (93.1%) were adherent to doses of ARVs by 15-days self-report. Adherence rate by unannounced pill count method was 88.1%. Multivariate analysis revealed that being unmarried (OR=0.119, CI=0.016-0.901, P=0.039), unemployment (OR=0.011, CI=0.000-0.288, P=0.007), not disclosing HIV status (OR=0.433, CI= 0.198-0.949, P=0.037), not getting support from family members (OR=0.393, CI=0.163-0.947, P=0.037) and others (OR=0.332, CI=0.144-0.845, P=0.043), alcohol drinking (OR=0.210, CI=0.071-0.617, P=0.003), being on regimens D4T(40)-3TC-NVP (OR=0.174, CI=0.033-0.923, P=0.040) and AZT-3TC-NVP (OR=0.172, CI=0.034-0.867, P=0.033) and three times daily dosing schedule (OR=0.073, CI=0.018-0.290, P=0.000) were ix associated with non-adherence to doses of ARVs. Confirming HIV status before 6 months prior to the date of interview (OR=4.064, CI=1.23-19.316, P=0.047) and MHS score of > 50 (OR=6.695, CI=1.534-29.218, P=0.011) were associated with better adherence to dose of ARVs. The cost of transport to health facilities and lack of food was reported as the main barrier to adherence to treatment by majority of participants of the FGDs. Drug side effects were less frequently cited as barriers to adherence in the present study. Participants who are male, employed, did not disclose their HIV status to others, had 6-12 classes of school, adhered better to doses and schedules of ARVs, obtained support from their family, with duration of HAART > 12 months and had recent CD4 cell count > 200 cells/mm3 were found to have higher mean scores for both summary scores of SF-36 (PHS and MHS scores). Conclusion and Recommendations: The adherence rate obtained by both 15-days self report and unannounced pill count was higher than the rates seen in developed countries despite the fact that many of participants live in very poor conditions and were on complex HAART regimens. Amharic version of SF-36 is valid and reliable health survey instrument to assess the QOL of PLWHA and on HAART. In order to maintain optimal adherence rate seen in this study, adherence-monitoring tools like pill counting should be introduced in all study sites; as these are the means to identify adherers and non-adherers to treatment and used to intervene with the problem. Future longitudinal research should be done to further strengthen the use of SF-36 for assessing the QOL of HIV-infected patients in Ethiopia setting. en
dc.publisher Addis Ababa University en
dc.relation.ispartof Masters Thesis - University of Auckland en
dc.rights Items in ResearchSpace are protected by copyright, with all rights reserved, unless otherwise indicated. Previously published items are made available in accordance with the copyright policy of the publisher. en
dc.rights.uri https://researchspace.auckland.ac.nz/docs/uoa-docs/rights.htm en
dc.title Highly active antiretroviral therapy adherence and its determinants in selected hospitals from SNNPR and Oromia regional states, Ethiopia en
dc.type Thesis en
thesis.degree.discipline Masters of Science in Pharmacoepidemiology and Social Pharmacy en
thesis.degree.grantor Addis Ababa University en
thesis.degree.level Masters en
dc.rights.holder Copyright: The author en
dc.rights.accessrights http://purl.org/eprint/accessRights/RestrictedAccess en
pubs.elements-id 675727 en
pubs.org-id Medical and Health Sciences en
pubs.org-id Pharmacy en
pubs.record-created-at-source-date 2017-09-26 en

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