An evaluation of determinants of adherence to antiretroviral therapy in AIDS patients in Gert Sibande District, Mpumalanga Province

Abstract

Introduction An estimated 11.4% of South Africans are infected with HIV. As of 2007, 1.7 million people required antiretroviral therapy (ART) and only 460 000 were reported to be on ART. ART can improve the quality of life and socio-economic status for HIV positive patients. This study aimed at evaluating the role played by the different factors in influencing treatment adherence among HIV patients on ART. Methods The study was conducted on patients receiving out-patient ART in two district hospitals (one urban and the other rural) of Mpumalanga Province, South Africa. The study project was approved by the Research and Ethics Committee of the University of Pretoria as well as by the Mpumalanga Provincial Department of Health. This was an analytical, cross-sectional study. The sample size for the study was 490 (245 per site). Facility-based patient appointment registers for the period June-August 2008 were used as the sampling frame. The respondents were selected through systematic random sampling. An interviewer directed standardised questionnaire was administered to the respondents after securing voluntary informed consent. Data were also extracted from the attendance registers in the two facilities. Adherence was measured using the Patient Medication Treatment Adherence Questionnaire. The Pearson chi-square test of association and binary logistic regression analysis were used for identifying significant predictors of non-adherence variables. Results Four hundred and twenty nine questionnaires of the 488 returned questionnaires were analysed. Sixty one questionnaires were disqualified due to incompleteness of data. The response rate was 99.7% in both study areas and participants reported adherence was 92.54%. The median age of the respondents was 36 (IQR, 13), gender distribution was 21.13% males and 78.87% females. The median duration of treatment (in months) with ART was 15 months (IQR, 18). Treatment adherence was higher in the urban than in the rural hospital. The variables that were significantly associated with non-adherence were ‘urban residence’ (OR 0.39 [0.2-0.8]); ‘lack of social support’ (OR 2.74 [1.3-5.7]); Discussion There were also some qualitative variables that had a bearing on quality of healthcare services that could explain differences between the rural and urban sites. Social support and urban residence demonstrated association with treatment adherence. Copyright