A study on determinants of adherence to highly active anti-retroviral therapy in a tertiary care hospital

Background: Acquired immunodeficiency syndrome (AIDS) caused by human immunodeficiency virus (HIV) is a major global health problem. A major concern with scaling up of antiretroviral treatment in resource limited settings is the emergence of drug resistant viral strains due to sub-optimal adherence and the transmission of these resistant viral strains in the population. Adherence is the second largest predictor of progression to AIDS and death after CD4 count. Hence the aim of the present study was to evaluate adherence to HAART and its determinants among HIV/AIDS patients on first line HAART. Methods: This study was cross-sectional, observational in nature carried out among two hundred and seventy (270) HIV/AIDS patients on HAART during December 2013 to November 2014 at ART centre. Frequencies, Proportions and logistic regression analysis were applied and statistical analysis was done using (SPSS) 17.0 version. Results: Among the study population, 52.6% of the patients were male, 81.5% of them were adherent to HAART in the last 7 days recall. Most common reasons for missing HAART regimen in this study were simply forgetting (70%). On Bivariate analysis, Adherence levels was less among Female (p <0.025) compared to male patients, Adherence levels were more among patients who were Employed (p <0.01) compared to unemployed, patients taking only HAART medications (p <0.000) when compared to patients taking more than or equal to four medications, those taking two to three medications (p <0.000) when compared to patients taking more than or equal to four medications, patients in WHO stage I (p <0.00) compared to patients in WHO stage III, patients in WHO stage II (p <0.032) compared to patients in stage III and lastly patients who were never admitted to hospital (p <0.008) due to HIV related illness in the previous year of HAART medication compared to those admitted more than once. Conclusions: Several demographic and treatment related factors influence adherence to HAART. Hence, addressing these factors and providing adherence support services are main strategies to decrease non-adherence and its consequences.