Patient's Psycho-Social,Treatment and Health Services Factors Affecting ART Adherence in Choma(Zambia)

Abstract

Research relating to factors responsible for adherence in Zambia has been limited. Clinic records at Choma show that the defaulter rate is at 9.9% (CIDRZ, 2007). This cross sectional study looked at common adherence problems like: level of adherence, patient factors, treatment factors, substance and alcohol, dietary restrictions, side effects and other factors that may be specific to poor settings. Respondents were drawn from; (i) patients on ARVs with a history of defaulting from the defaulter patient’s register or (ii) a member in a household with an adult taking ARVs (care giver). Data was collected using patient medical records and one to one interviews. Tests of associations using the Chi-square test or the Fisher’s exact test were done. SPSS logistic regression was used to determine predictability. Results showed that the majority of the respondents were from the 26-35 age group (35.2%) and women tended to be younger than males (26-53 age group). Most had never been to school or had only gone up to primary school (58.9%), were unemployed (34.6%), divorced or single (60.3%) and had no social support (52.4%). From treatment and service factors, 79.5% of respondents were not keen to take drugs, 63% experienced side effects and 61% said clinic waiting times were long. There was significant association between non-adherence to ART and some known social factors; social support P = 0.001, marital status p < 0.001 and one’s responsibility to take drugs p = 0.001.No significant association was found between non-adherence to ART and treatment factors; side effects p = 0.960 and discomforts p = 0.960. Service factors also had no association; patient education p = 0.066, availability of drugs p = 0.732, patient follow-ups p = 0.301 and long clinic waiting time p = 0.187. Married respondents were 48% (AOR = 0.52, 95% CI [0.31, 0.87]) less likely to miss clinic appointments, compared to respondents who were single.Respondents who had social support were 47% (AOR = 0.53, 95% CI [0.32, 0.90]) less likely to miss clinic appointments, compared to those who did not have social support.Respondents who were not keen to take medication were 72% (AOR = 1.72, 95% CI [1.03, 2.86]) more likely to miss clinic appointments, compared to those who were keen to take medication.To enhance ART adherence, the study recommends that, all patients should be encouraged to receive adherence counseling. Ministry of Health should promote Health education campaigns.