Determinants of Highly Active Antiretroviral Therapy (HAART) Adherence and Improved Quality of Life for People Living with Hiv/Aids (PLWHA) in Afar Region, Ethiopia
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Date
2009-10
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Addis Ababa University
Abstract
Background: Highly Active Antiretroviral Therapy (HAART) regimens greatly reduce the
morbidity and mortality associated with HIV infection, high adherence for an optimal response to
HAART is requirement. Unfortunately, adherence to HAART is difficult and poor adherence is
common. Low adherence and the closely related phenomenon of drug resistance are thought to be
the most important reasons for failed ARVs treatment. Better QOL score may relate with better
adherence to HAART regimens, better PHS and MHS score.
Objective: To determine the cutTent adherence rate and its determinants as well as to assess
quality of life of patients among PLWHA currently on HAART in Afar Region, Ethiopia.
Method: A cross-sectional Survey on assessment of factors affecting adherence to HAART was
conducted between August 2007 and October 2007 in selected health institution of Afar Region,
and both qualitative and quantitative data collection methods were employed in the stud y.
Results: A total of 422 PLWHA and currently on HAART were participated in the study. Study
participants were 222(52.6%) females and 200(47.4%) males, most of participants were in the
age group of 25-44. According to 15-days recall self-report, 402(95.3%) of participants were
adherent to doses of HAART. Adherence rate obtained from unannounced pill-count was also
53%. Traveling so could not keep the routine, too busy, lack of food and difficult to take many
pills were the most common reasons reported for missed doses. In multiple logistic regress ion
among the socio-demographic variables, employment was associated with better adherence score
(OR, .001; CI, .001-.344, P=.026). Pill burden (OR= .001, CI .001-.089, P=O.OOI) and long time
with virus (OR=.044, CI, .003-.714), P=0.028) were associated with better self-reported
adherence. Age (OR= 1l.822, CI 1.274-109.65, P=0.030), gender (OR= 16.19, CI 1.111 - 232. 18,
P=.046), level of education (OR= 12.899, CI l.007-165.242, P=0.049) also long time with
HAART (OR= 33.391, CI, l.066-1046.279, P=0.046) among factors weakly associates with
adherence. Shortage of medicines for OIs, quality of care, lack of income, and lack of food were
reported among the factors more affect adherence among most of FGDs participants. Stigma,
regimen factors like pill burden, side effect and structural issues were reported as factors less
affects adherence to HAART. Adherence was assoc iated with better PHS and M HS sco re, which
is to mean better QOL.
Conclnsion: self report HAART adherence rate in th is population is better than studies in hi gh
income countr ies as well as in Africa and in other Regions of Ethiopia, in spite of the fact th at
patients in Ethiopia face a large number of economical problems. However, non-adherence
remains an unsettling barrier for treatment success and is ever-present among patients receiving
ARYs therapy. To improve adherence establishing reliable drug supply, training of ex tra number
of staffs, simplifying dosage regimens and confidentiality should be mai ntained. Also study with
intervention with some adherence support program may help to address factors on non ad herence.
Key words: Highly Active Antiretroviral Therapy (HAART), Adherence, HIY/AlDS, Quality or
Life (QOL), SF-36, Afar Region, Ethiopia.
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Keywords
Highly Active Antiretroviral, Therapy (HAART), Adherence, HIV/AlDS, Quality or Life (QOL), SF-36, Afar Region, Ethiopia