DOWNLOAD PDF

Evaluating Non-Adherence to Antiretroviral Therapy among HIV/AIDS Patients at KIU Teaching Hospital’s ART Clinic: Insights into Knowledge, Attitudes, and Socio-Demographic Influences

Mafabi Denis

Department of Medicine and Surgery, Kampala International University, Uganda.

ABSTRACT

Uganda, one of the countries with the highest HIV burden, accounts for almost half of all new infections in the region. A study was conducted to assess knowledge, attitude towards non-adherence to ART, and socio-demographic factors associated with knowledge among people living with HIV/AIDS attending the ART clinic of KIU Teaching Hospital. A total of 167 participants were selected, and bivariate and multivariate logistic regression was performed to identify factors associated with knowledge on non-adherence to ART. The mean knowledge score was 8.54, with 73.65% of participants having high knowledge and 26.35% having low knowledge. Attitude towards non-adherence to ART was attitudinal, with 25.15% having an unfavorable attitude and 74.85% having a favorable attitude. Factors such as having more than 4 family members and living in a rural area were independently associated with knowledge on non-adherence to ART among PLHIV attending the ART clinic of Kampala International University teaching hospital.

Keywords: knowledge, attitudes, socio-demographic factors, antiretroviral therapy, HIV, AIDS

INTRODUCTION

Antiretroviral therapy has improved the health of many human immunodeficiency virus (HIV) positive individuals who otherwise would have died [1-3]. Treatment efficacy relies, however, on sustained adherence, which constitutes a serious challenge to those receiving antiretroviral therapy, the regimens are often complicated and can include varying dosing schedules, dietary restrictions, and adverse effects [4-8].  Adherence to ART results in successful HIV outcomes, which ensures optimal viral and CD4 control and prevention of further complications [9-13]. However, adherence to ART often poses a special challenge and requires commitment from the patient and the health care team. Due to rapid replication and mutation of HIV, poor adherence results in the development of drug-resistant strains of HIV [14-19].

In 2016, the Joint United Nations Programme on HIV/ AIDS (UNAIDS) estimated that 36.7 million people were living with HIV/AIDS including 19.5 million who were accessing antiretroviral therapy (ART) [20-25]. The global coverage of antiretroviral therapy reached 46% (43-50%) at the end of 2015. Gains were greatest in the world’s most affected region, eastern and southern Africa, where coverage increased from 24% (22-25%) in 2010 to 54% (50-58%) in 2015, reaching a total of 10.3 million people [26-30].

The African region remains the most affected region with 19.4 people living with HIV/AIDS (PLHIV) including 11.4 million PLHIV accessing ART [31-35]. Although the burden of HIV continues to vary significantly across countries, Sub-Saharan Africa remains the most affected with almost 1 in every 25 adults (4.4%) living with it, accounting for nearly 70% of the global burden [36-39].

According to the 2014 estimate the national HIV prevalence in Ethiopia was 1.14%, and the number of people living with HIV is 769, 600 with 15, 700 new HIV infections and 35, 600 AIDS-related deaths each year (Molla et al., 2018). Nigeria, with the 2016 population and housing census figure of 140,431,790, has the tenth largest population in the world and is the most populous country in Africa. It has been estimated that approximately 70% of Nigeria’s population is poor, and 55% is literate [40-48].

In Uganda, very little is known about the knowledge, attitudes and socio-demographic factors associated with knowledge on non-adherence to ART among people living with HIV/AIDS as evident by no published studies relating to the topic. It is on that background that the present study seeks to fill the knowledge and information gap [49-54].

METHODOLOGY

Study design

This was a hospital based cross-sectional observational study.

Study area

The study was conducted in the ART clinic at Kampala International University teaching hospital which is in Ishaka Town, a major town in Bushenyi district, and located in the north of Bushenyi district, south west of Mbarara district and around 78km from Mbarara town which is the biggest city in Western Uganda.

Study population

All people above 18 years of age living with HIV/AIDS in Ishaka-Bushenyi municipality constituted the study population for this study.

Target Population

The study targeted people living with HIV attending ART clinic at KIU-TH provided they met the inclusion criteria.

Sampling Technique

For the present study, the techniques selected for the study were based on probability sampling. The main method that was employed in selecting sample from the population was simple random sampling technique.

Simple random Sampling

With this method, the researcher identified the study population, chose the sample size, listed the population, assigned numbers to the units, found random numbers and selected the individuals to take part in the study. The aim of the simple random sample was to reduce the potential for human bias in the selection of cases to be included in the sample. Each of the PLHIV attending the ART clinic had equal chances of participating in the study.

Sample size determination

A formula by Charan & Biswas (2013) was used to determine the sample size for this study.

Where: n is the sample size

Z is the standard normal deviate or variant (at 5% type 1 error and p<0.05, Z is 1.96)

P is the expected proportion of characteristic being measured in the target population based on previous studies (For this study, it is estimated at 87.6% or 0.876) (Raberahona et al., 2019).

d is the absolute error or level of statistical significance (For this study set at 0.05)

Thus by using this formula,

Therefore, 167 was considered as the required sample size

Inclusion criteria

All people living with HIV/AIDS who were above 18 years of age and who consented to take part in the study were included.

Exclusion criteria

  • People living with HIV/AIDS who were on pre-ART
  • People living with HIV/AIDS who were below 18 years of age.

Study procedure

Participation to the study was proposed to all PLHIV who had gone to take ART and who met inclusion criteria. Participants were informed about the purpose of the study. Participants who finally signed a consent form were enrolled. Participants were interviewed by a trained investigator for about 10 to 20min. Interview was done in English or Lunyankole at the discretion of the participant and the investigator.

Data collection Instruments

A data collection instrument is a tool that is used in data collection such as a questionnaire. This provided a guide to the researcher to collect adequate data that helped him answer the research questions to achieve the study objectives.

Proof and data analysis

Data was entered using Microsoft Excel Version 13 and was analyzed using STATA 14.0, Prior to data entry, the data was coded and cleaned to look for inconsistencies and missing values. Cross checking was done where necessary.

Ethical considerations

For this study to be ethical, the following were considered.

RESULTS

The researcher carried out data collection between January 2019 and March 2020 from the HIV clinic at Kampala International University Teaching Hospital. During the period of data collection, 167 participants were recruited and luckily enough all the 167 participants consented to participate in the study, all the 167 participants fully filled and returned the questionnaires. Therefore, the response rate for this study was 100% of the calculated sample size. According to Morton, Robinson, & Carr (2012), a response rate of 70% and above is acceptable for most cross sectional studies.

Table 1 summarizes the categorical variables of the characteristics of the study participants, majority of the study participants 49.10% (82/167) were in the age group of 20 – 28 years, having 4 – 6 members in their families 42.51% (71/167) and 1 – 7 years was the during for which they had been taking ARV drugs 86.83% (145/167). Also, majority of study participants 39.52% (66/167) were in the Catholic denomination with their original areas of residence being rural areas 72.46% (121/167) and majority of the study participants 64.07% (107/167) were married. Basing on the highest level of education attained, majority of the participants 45.51% (76/167) had attained secondary education as their highest level of education. Lastly, when asked about their employment status, majority of the respondents 54.49% (91/167) stated that they were unemployed.

Table 1: Categorical variables of the socio-demographic characteristics of the study participants

CATEGORY OPTIONS FREQUENCY(n)       PERCENTAGE (%)
Age of the participants 20 – 28 Years 82 49.10
29 – 37 Years 67 40.12
38 – 46 Years 12 07.19
47 Years and above 06 03.59
Number of Family Members 1 – 3 members 59 35.33
4 – 6 members 71 42.51
7 members and above 37 22.16
Duration on ARVs 1 – 7 Years 145 86.83
8 – 14 Years 09 05.39
15 years and above 13 07.78
Religion Catholic 66 39.52
Anglican 56 33.53
Muslim 17 10.18
Others 28 16.77
Area of Residence Urban 46 27.54
Rural 121 72.46
Marital Status Single 24 14.37
Married 107 64.07
Divorced 18 10.78
Cohabiting 18 10.78
Education Level None 20 11.98
Primary 61 36.53
Secondary 76 45.51
Tertiary 10 05.99
Employment Status Employed 76 45.51
Unemployed 91 54.49

 

Presented in table 2 are the summary descriptive statistics for the continuous variables of the study participants. The mean age of the study participants was 30 years with a standard deviation of 7 years from the mean. The minimum age was 20 years whereas the maximum age was 55 years. The data on age of the study participants had a variance of 54.50 with a positive skewness of 1.31 and a platy kurtosis of 1.94. The mean number of family members in participants’ family was 4.71 with a standard deviation of 1.99, minimum of 1 member, maximum of 10 members, variance of 3.98 with a positive skewness of 0.69 and a meso kurtosis of 3.05. The mean number of years which during which the participants have been on ARVs was approximately 5 years, standard deviation of 4 years. The minimum duration was 1 year while the maximum duration was 19 years with a variance of 16.30, a positive skewness of 1.79 and a lepto kurtosis of 6.13.

Table 2: Continuous Variables Pertaining to Characteristics of the Study Participants

Variable Mean St Dev Med IQR Min Max Var Skewness Kurtosis  
Age 30.16 7.38 29 34, 25 20 55 54.50 1.31 1.94
Family Members 4.71 1.99 4 6, 3 1 10 3.98 0.69 3.05
Duration on ARVs 4.84 4.04 4 6, 2 1 19 16.30 1.79 6.13

St Dev = Standard Deviation, Med = Median, Min = Minimum, Max = Maximum, IQR = Inter quartile Range, Var = Variance.

During the research process, 12 questions were used to assess the knowledge of study participants on non-adherence to ART among people living with HIV/AIDS attending ART clinic of KIU-T. The responses are presented in table 3 below. Majority of the study participants 74.25% (124/167) knew the drug regimen which they were on and had ever heard about non-adherence to ART 86.23% (144/167). Majority of the study participants 73.65% (123/167) could correctly identify that non-adherence to ARVs increases the viral load of an individual. On the question regarding the result of not adhering to ARV drugs on CD4+ count, majority of study participants had correct knowledge with 52.10% (87/167) of study participants correctly identifying that it increases CD4+ count. The highest number 95.81% (160/167) knew that when a pregnant woman doesn’t adhere to ARV, it increases the risk of mother to child transmission. On the question of effect of missing doses of ARV on treatment effectiveness, majority of participants wrongly answered that it increases treatment effectiveness. On the other hand, 53.29% (89/167) said that taking ARVs together with food makes ARVs not to work well whereas 72.46% (121/167) stated that it is not okay to miss taking drugs. When the study participants were asked whether it is bad to share ARV drugs with another person, majority of study participants 65.87 (110/167) correctly said it is bad to share ARV drugs. Almost all the study participants 94.61% (158/167) could correctly identify that ARVs should be taken for lifetime. More than half of participants 53.29% (89/167) correctly answered that the purpose of ARVs is to suppress viral load and lastly, 88.62% (148/167) said it is bad to skip a day without taking ARV drugs.

 Table 3: Responses to Questions used to assess knowledge of study participants

VARIABLE FREQUENCY PERCENTAGE %)
Know the Drug Regimen they are on
Yes* 124 74.25
No 43 25.75
Ever heard about non-adherence to ART
Yes* 144 86.23
No 23 13.77
Effect of non-adherence  on Viral Load
Increases* 123 73.65
Decreases 42 25.15
Don’t Know 02 01.20
The result of not adhering to ARV drugs on CD4+ count
Increases 87 52.10
Decreases* 49 29.34
Don’t Know 31 18.57
Non Adherence among pregnant woman increases the risk of MTCT
Yes* 160 95.81
No 07 04.19

Continuation of Table 3

The effect of missed dose on treatment effectiveness
Increases 94 56.29
Reduces* 73 43.71
Effects of taking ARV drugs together with food
Makes ARVs work well 78 46.71
Makes ARVs not to work well* 89 53.29
It is okay to miss taking ARV drugs
Yes 46 27.54
No* 121 72.46
It is bad to share drugs with another person
Yes* 110 65.87
No 57 34.13
Duration for taking ARV drugs
Lifetime* 158 94.61
Some years 08 04.79
Don’t know 01 00.60
The purpose of ARV drugs
Cure HIV 68 40.72
Reduce pain 06 03.59
Suppress Viral Load* 89 53.29
Weight Gain 04 02.40
It is bad to skip a day without taking ARV drugs
Yes* 148 88.62
No 19 11.38

The correct response is marked with asterisk (*)

The study participants were awarded 1 mark for every question answered correctly and for every question answered wrongly, the participants were awarded 0 marks. Presented in table 4 is the summary statistics of the knowledge scores of the study participants. In cases where study participants answered all the questions correctly, the participant is supposed to score 12 points. There were 167 observations; the mean knowledge score was 8.5 with a standard deviation of 1.8 from the mean. The minimum score of knowledge was 4 while the maximum knowledge score was 11 with a variance of 3.1 and a negative skewness of -0.7 meanwhile there was a platy kurtosis 2.6

Table 4: The Summary of total Knowledge scores of study participants

Observations Mean Std Dev Minimum Maximum Variance Skewness Kurtosis
167 8.5 1.8 4 11 3.1 -0.7 2.6

Those who scored less than 60% were graded to be having low level of knowledge on non-adherence to ART whereas participants who had knowledge score of 60% and above were graded to be having high level of knowledge on non-adherence to ART. As shown in table 5, majority of the study participants 73.65% (123/167) had high level of knowledge regarding non-adherence to ART with a 95% confidence interval of 67.00 – 80.40 meanwhile 26.35% (44/167) were found to be having low level of knowledge about non-adherence to ART with a 95% confidence interval of 19.60 – 33.10.

Table 5: Shows grading of the knowledge scores

Level of Knowledge Frequency Percentage 95% Confidence Interval
Low 44 26.35 19.60 – 33.10
 

 

 
High 123 73.65 67.00 – 80.40

Figure 1; Bar Graph Showing the Level of Knowledge

Shown in table 6 below is the age-specific level of knowledge among the study participants. It can be observed that majority of study participants 76.12% (51/67) who had high level of knowledge were from the age group of 29 – 37 years at 95% CI of 65.64-86.60 meanwhile majority of the study participants 66.67% (04/06) who had low level of knowledge about non-adherence to ART were from the age group of 47 years and above at 95% CI of 12.47-120.8. Nevertheless, the difference in the level of knowledge across the different age groups of participants had no statistical significance since the P value was 0.127.

Table 6: Age-Specific Level of Knowledge on non-adherence to ART

Age of the study participants Total Knowledge Level Chi

 Square

 (Χ2)

 P Value
Low

Count,

(%)

 95% Confidence Interval High

Count, (%)

 95% Confidence Interval
20 – 28 82 20 (24.39) 14.90-33.89 62 (75.61) 66.12-85.10
29 – 37 67 16 (23.88) 13.40-34.36 51 (76.12) 65.64-86.60
38 – 46 12 04 (33.33) 02.05-64.62 08 (66.67) 35.38-97.95 5.70 0.127
47 or more 06 04 (66.67) 12.47-120.8 02 (33.33) -20.86-87.53

P Value is significant at 0.05 level

Figure 2: Bar Graph Showing Age-Specific Level of Knowledge

The researcher used 8 items to assess attitude of study participants, with each item having 2 options of agree (yes) and disagree (No). As observed from table 7, majority of participants 80.84% (135/167) said there are no other effective ways of treating HIV other than ARV drugs but unfortunately a high proportion 82.63% (138/167) were not convinced of getting infected with HIV with more than half of the study participants 62.87 (105/167) saying taking ARVs does more harm than good. As such, an exceedingly high numbers 90.42% (151/167) had no zeal to continue with taking the ARV drugs much as 68.86% (115/167) of the study participants never felt ashamed of taking ARV drugs. On the other hand, more than half of the study participants 57.49 (96/167) disagreed that those who are not adhering to ART may start falling sick frequently meanwhile 74.85% (15/167) of the participants had a perception that it is not dangerous not to adhere to ARV drugs.

Table 7: The Response of study participants to attitudinal questions

VARIABLE FREQUENCY PERCENTAGE %)
There are more effective ways to treat HIV than ARV drugs
Agree 32 19.16
Disagree 135 80.84
Convinced of being infected by HIV
Agree 29 17.37
Disagree 138 82.63
Convinced that ARVs are effective
Agree 84 50.30
Disagree 83 49.70
Taking ARV drugs does more harm than good
Agree 105 62.87
Disagree 62 37.13
Committed to continue on your ARV drugs
Agree 16 09.58
Disagree 151 90.42
Feels ashamed of taking ARV drugs
Agree 52 31.14
Disagree 115 68.86
Those who are not adhering to ART may start falling sick frequently
Agree 71 42.51
Disagree 96 57.49
It is dangerous not to adhere to ARV drugs
Agree 42 25.15
Disagree 125 74.85

Eight statements were used to assess the attitude of study participants towards non-adherence to ART. Participants were awarded 1 score for every statement with a favorable attitude, whereas responses with an unfavorable attitude were awarded 1 score. Table 8 shows the summary statistics of the attitude scores of the study participants. The total score if the participant has a favorable attitude in all items is supposed to be 8. There were 167 observations; the mean score was 5.42 with a standard deviation 1.50 from the mean. The minimum score of attitudes was 1 while the maximum attitude score was 8 with a variance of 2.24 and a negative skewness of 0.87 meanwhile there was a meso kurtosis of 3.81

Table 8: Summary statistics of At   titude Score of study participants

Observations Mean Std Dev Minimum Maximum Variance Skewness Kurtosis
167 5.42 1.50 1 8 2.24 – 0.87 3.81

Participants who had attitude sore of less than 5 were considered to be having an unfavorable attitude meanwhile study participants who had attitude score of 5 and above were considered to be having favorable attitude. As presented in table 9 below, majority of the study participants 74.85% (125/167) had favorable attitudes which would promote adherence  to ART with 95% CI of 68.20 – 81.50, meanwhile 25.15 (42/167) had unfavorable attitude which would promote non-adherence to ART with 95% CI of 18.50 – 31.80

                                                    Figure 3; Pie chart showing attitude scores

Table 9: Overall Grading of Attitude among the Study Participants

Grading of Attitude Frequency Percentage 95% CI
Unfavorable 42 25.15 18.50 – 31.80
Favorable 125 74.85 68.20 – 81.50

Age-Specific Attitude on Non-adherence to ART

Table 10 shows the age-specific attitude towards non-adherence to ART among study participants. The age group of 38 – 46 years had majority of participants 83.33% (10/12) with favorable attitude which can promote adherence to ART with 95% CI of 58.60-108.07 meanwhile majority of the study participants 33.33% (02/06) who had unfavorable attitude which can promote non-adherence to ART were from the age group of 47 years and above with 95% CI of -20.86-87.53. However, the difference in the attitude across the different age groups of participants was not significant with a P value of 0.837 and a chi square value of 0.852.

Table 10: Shows Age-Specific Attitude of Study Participants

Age of the study participants Total Attitude Chi

 Square

 (Χ2)

 P Value
Unfavorable

Count,

(%)

 95% Confidence Interval Favorable

Count, (%)

 95% Confidence Interval
20 – 28 82 22
(26.83)		 17.03-36.62 60 (73.17) 63.38-82.97
29 – 37 67 16
(23.88)		 13.40-34.36 51 (76.12) 65.64-86.60
38 – 46 12 02
(16.67)		 -08.07-41.40 10 (83.33) 58.60-108.07 0.852 0.837
47 or more 06 02
(33.33)		 -20.86-87.53 04 (66.67) 12.47-120.86

P Value is significant at 0.05 level

When a chi square test was done to check for associations between socio-demographic factors and the level of knowledge on non-adherence to ART among the study participants, results of the analysis revealed that four factors were significantly associated with the level of knowledge on non-adherence to ART among the study participants who were sampled during the study period as observed in table 11. The statistically significant factors include: Number of family members X2(3, N=167) =24.77, P<0.001; Area of residence X2(1, N=167) =9.601, P=0002; Marital Status X2(3, N=167) =19.114, P<0.001; Employment status X2(1, N=167) =6.056, P=0.014;  meanwhile all the other socio-demographic factors had no significant association with level of knowledge on non-adherence to ART.

Table 11: Chi Square Test to Show Association between Socio-Demographic Factors and Level of Knowledge on Non-adherence to ART

VARIABLE TOTAL KNOWLEDGE CHI

     SQUARE

(χ2)

 P VALUE
LOW

COUNT (%)

HIGH

(   COUNT (%)
Age of the participants 20 – 28 Years 82 20 (24.39) 62 (75.61)
29 – 37 Years 67 16 (23.88) 51 (76.12)
38 – 46 Years 12 04 (33.33) 08 (6.67) 5.70 0.127
47 Years and above 06 04 (66.67) 02 (33.33)
Number of Family Members 1 – 3 members 59 17 (28.81) 42 (71.19)
4 – 6 members 71 07 (09.86) 64 (90.14) 24.77 <0.001*
7 members and above 37 20 (54.05) 17 (45.95)
Duration on ARVs 1 – 7 Years 145 35 (24.14) 110 (75.86)
8 – 14 Years 09 02 (22.22) 07 (77.78) 5.51 0.064
15 years and above 13 07 (53.85) 06 (46.15)

 

Cont. of Table 12

*Religion Catholic 66 12 (18.18) 54 (81.82)
Anglican 56 18 (32.14) 38 (67.86)
Muslim 17 03 (17.65) 14 (82.35) 6.32 0.097
Others 28 11 (39.29) 17 (60.71)
Area of Residence Urban 46 20 (43.48) 26 (56.52) 9.601 0.002*
Rural 121 24 (19.83) 97 (80.17)
Marital Status Single 24 14 (58.33) 10 (41.67)
Married 107 18 (16.82) 89 (83.18)
Divorced 18 07 (38.89) 11 (61.11) 19.114 <0.001*
Cohabiting 18 05 (27.78) 13 (72.22)
Education Level None 20 05 (25.00) 15 (75.00)
Primary 61 18 (29.51) 43 (70.49)
Secondary 76 18 (23.68) 58 (76.32) 0.679 0.878
Tertiary 10 03 (30.00) 07 (70.00)
Employment Status Employed 76 27 (35.53) 49 (64.47) 6.056 0.014*
Unemployed 91 17 (18.68) 74 (81.32)

P value is significant a value less than 0.05

Table 12 presents bivariate logistic regression and multivariate logistic regression to establish the factors associated with knowledge on non-adherence to ART among people living with HIV attending Kampala International University Teaching hospital ART clinic. Results of the analysis showed that at bivariate logistic regression 7 socio-demographic factors were found to be statistically associated with the level of knowledge on non-adherence to ART among the study participants. Participants who were in the age group of 47 years and above were 84% less likely to have a high level of knowledge compared to participants who were in the age group of 20 – 28 years  (cOR 0.16, 95%CI 0.03-0.95, P=0.043).

Those who had 4-6 family members were almost 4 times more likely to have high level of knowledge than those who had 1 – 3 family members (cOR 3.70, 95%CI 1.41-9.69, P=0. 0.008) whereas participants who had 7 or more family members were 66% less likely to have high level of knowledge than participants who has 1 – 3 family members (cOR 0.34, 95%CI 0.15-0.81, P=0.015). Participants who had been on ART for 4 – 6 years were 3.67 times more likely to have a high level of knowledge than participants who had been on ART for 1 – 7 years (cOR 3.67, 95%CI 1.16-11.64, P=0.027). Those who belonged to other religions apart from Catholic, Anglican and Muslim were 66% less likely to have high knowledge compared to participants who were Catholics (cOR 0.34, 95%CI 0.13-0.92, P=0.033).

Those coming from rural areas of residence were 3.11 times more likely to have high levels of knowledge than those coming from urban areas of residence (cOR 3.11, 95%CI 1.49-6.48, P=0.002). Married participants were 6.92 times more likely to have high level of knowledge than the single participants (cOR 3.11, 95%CI 2.66-18.02, P<0.001) and lastly, unemployed participants were 2.40 times more likely to have high level of knowledge than the employed participants (cOR 2.40, 95%CI 1.18-4.86, P=0.015).

Factors with p-value less than 0.20 with at bivariate logistic regression analysis were considered for multivariate analysis. Through a stepwise logistic regression with removal of least significant variable in each step, only number of family members and area of residence remained significantly associated with the level of knowledge of participants on non-adherence to ART.
4 – 6 family members versus 1 – 3 family members (aOR 4.21, 95%CI 1.29-13.76, P=0.018),
and rural versus urban (aOR 2.80, 95%CI 1.00-7.84, P=0.049).

Table 12: Logistic Regression Analysis to Show Factors Associated with Knowledge of Study Participants

Variables Knowledge Level cOR (95% CI) P Value aOR (95% CI) P Value
Low

n=44 (%)

 High

n=123 (%)
Age of the participants
20 – 28 Years 20 (24.39) 62 (75.61) 1 – 1 –
29 – 37 Years 16 (23.88) 51 (76.12) 1.03 (0.48-2.19) 0.942 0.89 (0.30-2.61) 0.832
38 – 46 Years 04 (33.33) 08 (6.67) 0.65 (0.18-2.37) 0.509 0.20 (0.02-1.72) 0.141
47 Years or + 04 (66.67) 02 (33.33) 0.16 (0.03-0.95) 0.043* 0.45 (0.03-7.63) 0.579
Number of Family Members
1 – 3 members 17 (28.81) 42 (71.19) 1 – 1 –
4 – 6 members 07 (09.86) 64 (90.14) 3.70 (1.41-9.69) 0.008* 4.21 (1.29-13.76) 0.018*
7 members or + 20 (54.05) 17 (45.95) 0.34 (0.15-0.81) 0.015* 0.34 (0.06-1.84) 0.211
Duration on ARVs
1 – 7 Years 35 (24.14) 110(75.86) 1 – 1 –
8 – 14 Years 02 (22.22) 07 (77.78) 3.67 (1.16-11.64) 0.027* 0.45 (0.04-5.36) 0.531
15 years or + 07 (53.85) 06 (46.15) 4.08 (0.60-27.65) 0.149 2.46 (0.14-43.49 0.540
Religion
Catholic 12 (18.18) 54 (81.82) 1 – 1 –
Anglican 18 (32.14) 38 (67.86) 0.47 (0.20-1.09) 0.077 0.47 (0.15-1.51) 0.203
Muslim 03 (17.65) 14 (82.35) 1.04 (0.26-4.18) 0.959 0.53 (0.09-3.24) 0.494
Others 11 (39.29) 17 (60.71) 0.34 (0.13-0.92) 0.033* 0.46 (0.12-1.79) 0.263
Area of Residence
Urban 20 (43.48) 26 (56.52) 1 – – –
Rural 24 (19.83) 97 (80.17) 3.11 (1.49-6.48) 0.002* 2.80 (1.00-7.84) 0.049*
Marital Status
Single 14 (58.33) 10 (41.67) 1 – 1 –
Married 18 (16.82) 89 (83.18) 6.92 (2.66-18.02) <0.001* 2.05 (0.48-8.76) 0.333
Divorced 07 (38.89) 11 (61.11) 2.2 (0.63-7.67) 0.215 1.78 (0.22-14.16) 0.584
Cohabiting 05 (27.78) 13 (72.22) 3.64 (0.98-13.52) 0.054 1.80 (0.29-11.13) 0.528

Cont. of Table 12

Education Level
None 05 (25.00) 15 (75.00) 1 – – –
Primary 18 (29.51) 43 (70.49) 0.80 (0.25-2.52) 0.698 – –
Secondary 18 (23.68) 58 (76.32) 1.07 (0.34-3.37) 0.902 – –
Tertiary 03 (30.00) 07 (70.00) 0.78 (0.14-4.21) 0.771 – –
Employment Status
Employed 48 (47.52) 53 (52.48) 1 – 1 –
Unemployed 38 (55.88) 30 (44.12) 2.40 (1.18-4.86) 0.015* 1.64 (0.59-4.61) 0.345

cOR= Crude Odds Ratio. aOR=Adjusted Odds Ratio CI=Confidence Interval.
P Value significant at 0.05 level

DISCUSSION

This study discovered that the mean knowledge score among the study participants was 8.54 with a standard deviation of 1.76 from the mean. Majority of the study participants 73.65% (123/167) had high level of knowledge on non-adherence to ART. This is in line with the results of a study done among young adolescent girls and young adults in Soweto, South Africa [55]. Similarly, the result of the present study is in line with the findings of a hospital based cross sectional study which revealed that 75.8% of respondents stated correctly that ART consists of drugs that suppress the activity of HIV.

The mean knowledge score found in the present study is higher than the mean score of 7 found in a cross-sectional study done from Madagascar, though the 73.65% of the participants with high level of knowledge found in the present study is low when compared to 87.6% of the participants who exhibited a good awareness [31]. The disparity in the study findings could have risen to the difference in the sample sizes of the two studies whereby the present study utilized a smaller sample size.

Also, the finding of the present study is higher than what was found in a study done in Nigeria which revealed that revealed that 65.9% of the respondents knew that ARV drugs are used for reducing progression of HIV [56]. Much as both studies were conducted from tertiary health facilities, the disagreement in the study findings could have come about due to the difference in the sampling techniques and the variations in the study populations.

The level of knowledge of participants in this study is low as compared to the findings of a study conducted by Olowookere et al.[40] which revealed that 75.8% of respondents stated correctly that ART consists of drugs that suppress the activity of HIV meanwhile in the present study only 53.29% correctly answered that ARVs suppress viral load. Despite the fact that both studies are hospital based cross sectional studies, the discrepancy in the study findings could have come about due to the smaller size in the present study.

To increase the level of knowledge on non-adherence even further, an inaccuracy of the ART programmes should be addressed; this should include improving knowledge translation during training of ART programme staff, ensuring the implementation of established data verification policies and procedures, rethinking the design of the programme to reduce the burden on health facilities and personnel, and standardizing information management procedures amongst the various governmental and non-governmental stakeholders [57].

The second specific objective of this study was to determine the attitudes towards noon-adherence to ART among people living with HIV attending ART clinic of Kampala International University teaching hospital. Findings of the present study showed that; 25.15% had unfavorable attitude, 74.85% had favorable attitude. The result of the present study is in line with what was found in a study conducted from South Africa [55].

Similarly, the findings of this study is in line with the result of a study conduted by [56-59] who discovered that median score for attitude and perception was 5 and participants who had a positive attitude and perception were 75.6%. In the same line, the result of the present study is in agreement with the result of a cross-sectional study conducted among 351 ART patients in the ART clinic of the University of Gondar referral hospital [56-59]. The possible reason for the agreement in the study findings could be due to the similarity in the study design and the similarity in the study settings. Also, the similarity in the sampling techniques employed could have brought about the agreement in the study findings.

The attitude of participants in the present study is more favorable in promoting adherence to ART than what was found in a facility-based study conducted in Nigeria which revealed that most respondents strongly agreed that ART had a positive effect on health (54.6%), had more benefits than harm (47.6%), reduces frequent sickness (46.8%) [56]. The difference in the study findings could have risen due the fact that the previous study was conducted in West Africa whereas the present study was done in East Africa.

The attitude of participants found in the present study is less favorable in promoting adherence to ART as compared to the findings of a study done in Ethiopia [56-59]. The difference in the study findings can be explained by the difference in the study settings and the different study populations.

The finding of the present study is in disagreement with the results of a study done among people living with HIV/AIDS in Madagascar. Furthermore, the results of present study do not agree with the results of a study done among HIV patients in southwest Nigeria [56-59]. Additionally, the results of a study conducted in Ethiopia showed that there was no significant association between the socio-demographic variables and knowledge non-adherence to antiretroviral therapy. This finding is not in line with what was found in the present study. The discrepancy in study findings could have come about due to the variation in study participants and difference in study settings.

The number of family members may influence the level of knowledge on non-adherence to ART in that when an HIV patient comes from a family where there are more than 4 members, there is a high possibility that some of the family members may be highly educated and will in turn enlighten the HIV patient about non-adherence to ART. On the other hand, area of residence also influences the level of knowledge on non-adherence to ART in that those coming from urban areas of residence engage in types of income generating activities or jobs which limit their time of attending to health facilities. Conversely, HIV patients who dwell in rural areas engage in income generating activities which doesn’t keep them very busy, as such they have enough time to receive quality counseling and health education from health care providers.

CONCLUSION

This study has shown that a large proportion of the study participants have high level of knowledge on non-adherence to ART, this is also related to the big number of study participants having attitude which is favorable in promoting adherence to ART. Having more than 4 family members and rural area of residence were independently associated with the level of knowledge.

REFERENCES

  1. Obeagu EI, Alum EU, Obeagu GU. Factors associated with prevalence of HIV among youths: A review of Africa perspective. Madonna University journal of Medicine and Health Sciences ISSN: 2814-3035. 2023;3(1):13-8.
  2. Obeagu EI, Okwuanaso CB, Edoho SH, Obeagu GU. Under-nutrition among HIV-exposed Uninfected Children: A Review of African Perspective. Madonna University journal of Medicine and Health Sciences ISSN: 2814-3035. 2022;2(3):120-7.
  3. Obeagu EI. A Review of Challenges and Coping Strategies Faced by HIV/AIDS Discordant Couples. Madonna University journal of Medicine and Health Sciences ISSN: 2814-3035. 2023;3(1):7-12.
  4. Res JAC, Dibaba B, Hussein M. AIDS & Clinical Research Factors Associated with Non-Adherence to Antiretroviral Therapy among Adults living with HIV / AIDS in Arsi Zone, Oromia, 2017; 8(1), 1–8. https://doi.org/10.4172/2155-6113.1000647
  5. Obeagu EI. A Review of Challenges and Coping Strategies Faced by HIV/AIDS Discordant Couples. Madonna University journal of Medicine and Health Sciences ISSN: 2814-3035. 2023 Jan 1;3(1):7-12.
  6. Obeagu EI, Obeagu GU. An update on premalignant cervical lesions and cervical cancer screening services among HIV positive women. J Pub Health Nutri. 2023; 6 (2). 2023; 141:1-2.
  7. Omo-Emmanuel UK, Chinedum OK, Obeagu EI. Evaluation of laboratory logistics management information system in HIV/AIDS comprehensive health facilities in Bayelsa State, Nigeria. Int J Curr Res Med Sci. 2017;3(1):21-38.
  8. Ezeoru VC, Enweani IB, Ochiabuto O, Nwachukwu AC, Ogbonna US, Obeagu EI. Prevalence of Malaria with Anaemia and HIV status in women of reproductive age in Onitsha, Nigeria. Journal of Pharmaceutical Research International. 2021;33(4):10-9.
  9. Erah PO, Arute JE. Adherence of HIV/AIDS patients to antiretroviral therapy in a tertiary health facility in Benin City. African Journal of Pharmacy and Pharmacology, 2008; 2(7), 145–152.
  10. Obeagu EI, Obeagu GU, Musiimenta E, Bot YS, Hassan AO. Factors contributing to low utilization of HIV counseling and testing services. Int. J. Curr. Res. Med. Sci. 2023;9(2):1-5.
  11. Obeagu EI, Obeagu GU. An update on survival of people living with HIV in Nigeria. J Pub Health Nutri. 2022; 5 (6). 2022;129.
  12. Obeagu EF, Onyenweaku FC, Nwobodo HA, Ochei KC, Ochiabuto Ogochukwu MT, Onwuasoanya UF. Impact of HIV and hepatitis b virus coinfection on selected haematological markers of the patients in Umuahia, Abia State, Nigeria. Ann Clin Lab Res. 2017;5(2):175.
  13. Offie DC, Obeagu EI, Akueshi C, Njab JE, Ekanem EE, Dike PN, Oguh DN. Facilitators and barriers to retention in HIV care among HIV infected MSM attending Community Health Center Yaba, Lagos Nigeria. Journal of Pharmaceutical Research International. 2021 Nov 30;33(52B):10-9.
  14. HIV Drug resistance fact sheet. World Health Organization. 2011.
  15. Obeagu EI, Ogbonna US, Nwachukwu AC, Ochiabuto O, Enweani IB, Ezeoru VC. Prevalence of Malaria with Anaemia and HIV status in women of reproductive age in Onitsha, Nigeria. Journal of Pharmaceutical Research International. 2021 Feb 23;33(4):10-9.
  16. Odo M, Ochei KC, Obeagu EI, Barinaadaa A, Eteng UE, Ikpeme M, Bassey JO, Paul AO. TB Infection Control in TB/HIV Settings in Cross River State, Nigeria: Policy Vs Practice. Journal of Pharmaceutical Research International. 2020 Sep 18;32(22):101-9.
  17. Obeagu EI, Eze VU, Alaeboh EA, Ochei KC. Determination of haematocrit level and iron profile study among persons living with HIV in Umuahia, Abia State, Nigeria. J BioInnovation. 2016; 5:464-71.
  18. Ifeanyi OE, Obeagu GU. The values of prothrombin time among HIV positive patients in FMC owerri. International Journal of Current Microbiology and Applied Sciences. 2015;4(4):911-6.
  19. Izuchukwu IF, Ozims SJ, Agu GC, Obeagu EI, Onu I, Amah H, Nwosu DC, Nwanjo HU, Edward A, Arunsi MO. Knowledge of preventive measures and management of HIV/AIDS victims among parents in Umuna Orlu community of Imo state Nigeria. Int. J. Adv. Res. Biol. Sci. 2016;3(10):55-65.
  20. Prevention gap report. Geneva. 2016.
  21. Chinedu K, Takim AE, Obeagu EI, Chinazor UD, Eloghosa O, Ojong OE, Odunze U. HIV and TB co-infection among patients who used Directly Observed Treatment Short-course centres in Yenagoa, Nigeria. IOSR J Pharm Biol Sci. 2017;12(4):70-5.
  22. Nwosu DC, Obeagu EI, Nkwocha BC, Nwanna CA, Nwanjo HU, Amadike JN, Elendu HN, Ofoedeme CN, Ozims SJ, Nwankpa P. Change in Lipid Peroxidation Marker (MDA) and Non enzymatic Antioxidants (VIT C & E) in HIV Seropositive Children in an Urban Community of Abia State. Nigeria. J. Bio. Innov. 2016;5(1):24-30.
  23. Igwe CM, Obeagu IE, Ogbuabor OA. Clinical characteristics of people living with HIV/AIDS on ART in 2014 at tertiary health institutions in Enugu, Nigeria. J Pub Health Nutri. 2022; 5 (6). 2022;130.
  24. Ifeanyi OE, Obeagu GU, Ijeoma FO, Chioma UI. The values of activated partial thromboplastin time (APTT) among HIV positive patients in FMC Owerri. Int J Curr Res Aca Rev. 2015; 3:139-44.
  25. Obiomah CF, Obeagu EI, Ochei KC, Swem CA, Amachukwu BO. Hematological indices o HIV seropositive subjects in Nnamdi Azikiwe University teaching hospital (NAUTH), Nnewi. Ann Clin Lab Res. 2018;6(1):1-4.
  26. Global health estimates 2015: deaths by cause, age, sex, by country and by region, 2000–2015. Geneva. 2016.
  27. Omo-Emmanuel UK, Ochei KC, Osuala EO, Obeagu EI, Onwuasoanya UF. Impact of prevention of mother to child transmission (PMTCT) of HIV on positivity rate in Kafanchan, Nigeria. Int. J. Curr. Res. Med. Sci. 2017;3(2):28-34.
  28. Obeagu EI, Amekpor F, Scott GY. An update of human immunodeficiency virus infection: Bleeding disorders. J Pub Health Nutri. 2023; 6 (1). 2023;139.
  29. Aizaz M, Abbas FA, Abbas A, Tabassum S, Obeagu EI. Alarming rise in HIV cases in Pakistan: Challenges and future recommendations at hand. Health Science Reports. 2023;6(8):e1450.
  30. Walter O, Anaebo QB, Obeagu EI, Okoroiwu IL. Evaluation of Activated Partial Thromboplastin Time and Prothrombin Time in HIV and TB Patients in Owerri Metropolis. Journal of Pharmaceutical Research International. 2022 Jan 21:29-34.
  31. Raberahona M, Lidamahasolo Z, Andriamamonjisoa J, Andriananja V. Knowledge , attitudes , perception and practices regarding antiretroviral therapy among HIV-infected adults in Antananarivo , Madagascar : a cross-sectional survey, 2019; 3, 1–9.
  32. Odo M, Ochei KC, Obeagu EI, Barinaadaa A, Eteng EU, Ikpeme M, Bassey JO, Paul AO. Cascade variabilities in TB case finding among people living with HIV and the use of IPT: assessment in three levels of care in cross River State, Nigeria. Journal of Pharmaceutical Research International. 2020 Oct 1;32(24):9-18.
  33. Jakheng SP, Obeagu EI. Seroprevalence of human immunodeficiency virus based on demographic and risk factors among pregnant women attending clinics in Zaria Metropolis, Nigeria. J Pub Health Nutri. 2022; 5 (8). 2022;137.
  34. Oloro OH, Oke TO, Obeagu EI. Evaluation of Coagulation Profile Patients with Pulmonary Tuberculosis and Human Immunodeficiency Virus in Owo, Ondo State, Nigeria. Madonna University journal of Medicine and Health Sciences ISSN: 2814-3035. 2022 Oct 16;2(3):110-9.
  35. Obeagu EI, Ibeh NC, Nwobodo HA, Ochei KC, Iwegbulam CP. Haematological indices of malaria patients coinfected with HIV in Umuahia. Int. J. Curr. Res. Med. Sci. 2017;3(5):100-4.
  36. Molla AA, Gelagay AA, Mekonnen HS,Teshome DF. Adherence to antiretroviral therapy and associated factors among HIV positive adults attending care and treatment in University of Gondar Referral Hospital , Northwest Ethiopia, 2018; 1–8.
  37. Viola N, Kimono E, Nuruh N, Obeagu EI. Factors Hindering Elimination of Mother to Child Transmission of HIV Service Uptake among HIV Positive Women at Comboni Hospital Kyamuhunga Bushenyi District. Asian Journal of Dental and Health Sciences. 2023 Jun 15;3(2):7-14.
  38. Ezugwu UM, Onyenekwe CC, Ukibe NR, Ahaneku JE, Onah CE, Obeagu EI, Emeje PI, Awalu JC, Igbokwe GE. Use of ATP, GTP, ADP and AMP as an Index of Energy Utilization and Storage in HIV Infected Individuals at NAUTH, Nigeria: A Longitudinal, Prospective, Case-Controlled Study. Journal of Pharmaceutical Research International. 2021 Oct 25;33(47A):78-84.
  39. Vincent CC, Obeagu EI, Agu IS, Ukeagu NC, Onyekachi-Chigbu AC. Adherence to Antiretroviral Therapy among HIV/AIDS in Federal Medical Centre, Owerri. Journal of Pharmaceutical Research International. 2021 Dec 14;33(57A):360-8.
  40. Olowookere SA, Fatiregun AA, Adewole IF. Knowledge and attitudes regarding HIV / AIDS and antiretroviral therapy among patients at a Nigerian treatment clinic Original Article Knowledge and attitudes regarding HIV / AIDS and antiretroviral therapy among patients at a Nigerian treatment clinic, 2012; https://doi.org/10.3855/jidc.2086
  41. Madekwe CC, Madekwe CC, Obeagu EI. Inequality of monitoring in Human Immunodeficiency Virus, Tuberculosis and Malaria: A Review. Madonna University journal of Medicine and Health Sciences ISSN: 2814-3035. 2022 Sep 24;2(3):6-15.
  42. Obeagu EI, Scott GY, Amekpor F, Obeagu GU. Implications of CD4/CD8 ratios in Human Immunodeficiency Virus infections. Int. J. Curr. Res. Med. Sci. 2023;9(2):6-13.
  43. Obeagu EI, Ochei KC, Okeke EI, Anode AC. Assessment of the level of haemoglobin and erythropoietin in persons living with HIV in Umuahia. Int. J. Curr. Res. Med. Sci. 2016;2(4):29-33.
  44. Ifeanyi OE, Obeagu GU. The Values of CD4 Count, among HIV Positive Patients in FMC Owerri. Int. J. Curr. Microbiol. App. Sci. 2015;4(4):906-10.
  45. Obeagu EI, Okeke EI, Anonde Andrew C. Evaluation of haemoglobin and iron profile study among persons living with HIV in Umuahia, Abia state, Nigeria. Int. J. Curr. Res. Biol. Med. 2016;1(2):1-5.
  46. Obeagu EI, Obeagu GU, Paul-Chima UO. Stigma Associated With HIV. AIDS: A Review. Newport International Journal of Public Health and Pharmacy (Nijpp). 2023;3(2):64-7.
  47. Alum EU, Ugwu OP, Obeagu EI, Okon MB. Curtailing HIV/AIDS Spread: Impact of Religious Leaders. Newport International Journal of Research in Medical Sciences (NIJRMS). 2023;3(2):28-31.
  48. Obeagu EI, Obarezi TN, Omeh YN, Okoro NK, Eze OB. Assessment of some haematological and biochemical parametrs in HIV patients before receiving treatment in Aba, Abia State, Nigeria. Res J Pharma Biol Chem Sci. 2014; 5:825-30.
  49. Alum EU, Obeagu EI, Ugwu OP, Aja PM, Okon MB. HIV Infection and Cardiovascular Diseases. The Obnoxious Duos. NEWPORT INTERNATIONAL JOURNAL OF RESEARCH IN MEDICAL SCIENCES (NIJRMS). 2023;3(2):95-9.
  50. Obeagu EI, Okoroiwu IL, Ochei KC, Okoro NK, Udenze CL. CD4 count of ART and Non-ART HIV positive patients attending Living Word Mission Hospital Abayi Aba. Abia State, Nigeria. 2014.
  51. Nwosu DC, Obeagu EI, Nkwuocha BC, Nwanna CA, Nwanjo HU, Amadike JN, Ezemma MC, Okpomeshine EA, Ozims SJ, Agu GC. Alterations in superoxide dismutiase, vitamins C and E in HIV infected children in Umuahia, Abia state. International Journal of Advanced Research in Biological Sciences. 2015;2(11):268-71.
  52. Chinenyeike Offie D, Ifeanyi Obeagu E, Akueshi C, E Njab J, E Ekanem E, Nnoaharam Dike P, Nnaoma Oguh D. Facilitators and Barriers to Retention in HIV Care among HIV Infected MSM Attending Community Health Center Yaba, Lagos Nigeria.
  53. Ifeanyi OE, Uzoma OG, Stella EI, Chinedum OK, Abum SC. Vitamin D and insulin resistance in HIV sero positive individuals in Umudike. Int. J. Curr. Res. Med. Sci. 2018;4(2):104-8.
  54. Ifeanyi O, Uzoma O, OMTB O, Felix E, Stella E, Chinedum O. Evaluation of Some Cytokines, CD4, Hepcidin, Iron Profile and Some Haematological Parameters of Pulmonary Tuberculosis Patients Coinfected with HIV in Southeast of Nigeria. Journal of Pharmaceutical Research International. 2020 Aug 5;32(13):118-30.
  55. Hornschuh S, Dietrich JJ, Tshabalala C, Laher F. Antiretroviral Treatment Adherence : Knowledge and Experiences among Adolescents and Young Adults in Soweto , South Africa, 2017.
  56. Balogun MR. Knowledge and attitude towards antiretroviral therapy and adherence pattern of HIV patients in southwest Nigeria, 2019; https://doi.org/10.3396/IJIC.v10i3.024.1
  57. Emmanuel Ifeanyi Obeagu, Getrude Uzoma Obeagu and Ugwu Okechukwu Paul-Chima (2023). Stigma Associated With HIV/AIDS: A Review. NEWPORT INTERNATIONAL JOURNAL OF PUBLIC HEALTH AND PHARMACY (NIJPP) 3(2):64-67.
  58. Esther Ugo Alum, Okechukwu P. C. Ugwu, Emmanuel Ifeanyi Obeagu and Michael Ben Okon (2023). Curtailing HIV/AIDS Spread: Impact of Religious Leaders. NEWPORT INTERNATIONAL JOURNAL OF RESEARCH IN MEDICAL SCIENCES (NIJRMS) 3(2): 28-31.
  59. Emmanuel Ifeanyi Obeagu, Stella Malot, Getrude Uzoma Obeagu and Okechukwu Paul-Chima Ugwu (2023).HIV resistance in patients with Sickle Cell Anaemia. NEWPORT INTERNATIONAL JOURNAL OF SCIENTIFIC AND EXPERIMENTAL SCIENCES (NIJSES) 3 (2):56-59.
CITE AS: Mafabi Denis (2023). Evaluating Non-Adherence to Antiretroviral Therapy among HIV/AIDS Patients at KIU Teaching Hospital’s ART Clinic: Insights into Knowledge, Attitudes, and Socio-Demographic Influences. NEWPORT INTERNATIONAL JOURNAL OF RESEARCH IN MEDICAL SCIENCES (NIJRMS) 4(1):131-147

DOWNLOAD PDF