Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study.
BACKGROUND: Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understa...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2012-01-01
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| Series: | PLoS ONE |
| Online Access: | http://europepmc.org/articles/PMC3341373?pdf=render |
| _version_ | 1818602084054859776 |
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| author | Sharada P Wasti Padam Simkhada Julian Randall Jennifer V Freeman Edwin van Teijlingen |
| author_facet | Sharada P Wasti Padam Simkhada Julian Randall Jennifer V Freeman Edwin van Teijlingen |
| author_sort | Sharada P Wasti |
| collection | DOAJ |
| description | BACKGROUND: Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. METHODS: A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. RESULTS: A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014); alcohol use (OR = 12.89, p = <0.001), being female (OR = 6.91, p = 0.001), being illiterate (OR = 4.58, p = 0.015), side-effects (OR = 6.04, p = 0.025), ART started ≤24 months (OR = 3.18, p = 0.009), travel time to hospital >1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. CONCLUSION: Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients' lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients. |
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| format | Article |
| id | doaj.art-278827a87e284220bb5f79453876bb4c |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-16T13:01:39Z |
| publishDate | 2012-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-278827a87e284220bb5f79453876bb4c2022-12-21T22:30:49ZengPublic Library of Science (PLoS)PLoS ONE1932-62032012-01-0175e3554710.1371/journal.pone.0035547Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study.Sharada P WastiPadam SimkhadaJulian RandallJennifer V FreemanEdwin van TeijlingenBACKGROUND: Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence to antiretroviral drugs is essential for HIV infection management. This study aimed to understand the factors influencing adherence amongst ART-prescribed patients and care providers in Nepal. METHODS: A cross-sectional mixed-methods study surveying 330 ART-prescribed patients and 34 in-depth interviews with three different types of stakeholders: patients, care providers, and key people at policy level. Adherence was assessed through survey self-reporting and during the interviews. A multivariate logistic regression model was used to identify factors associated with adherence, supplemented with a thematic analysis of the interview transcripts. RESULTS: A total of 282 (85.5%) respondents reported complete adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence were: non-disclosure of HIV status (OR = 17.99, p = 0.014); alcohol use (OR = 12.89, p = <0.001), being female (OR = 6.91, p = 0.001), being illiterate (OR = 4.58, p = 0.015), side-effects (OR = 6.04, p = 0.025), ART started ≤24 months (OR = 3.18, p = 0.009), travel time to hospital >1 hour (OR = 2.84, p = 0.035). Similarly, lack of knowledge and negative perception towards ART medications also significantly affected non-adherence. Transport costs (for repeat prescription), followed by pills running out, not wanting others to notice, side-effects, and being busy were the most common reasons for non-adherence. The interviews also revealed religious or ritual obstacles, stigma and discrimination, ART-associated costs, transport problems, lack of support, and side-effects as contributing to non-adherence. CONCLUSION: Improving adherence requires a supportive environment; accessible treatment; clear instructions about regimens; and regimens tailored to individual patients' lifestyles. Healthcare workers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence among ART-prescribed patients.http://europepmc.org/articles/PMC3341373?pdf=render |
| spellingShingle | Sharada P Wasti Padam Simkhada Julian Randall Jennifer V Freeman Edwin van Teijlingen Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study. PLoS ONE |
| title | Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study. |
| title_full | Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study. |
| title_fullStr | Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study. |
| title_full_unstemmed | Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study. |
| title_short | Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study. |
| title_sort | factors influencing adherence to antiretroviral treatment in nepal a mixed methods study |
| url | http://europepmc.org/articles/PMC3341373?pdf=render |
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