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Adherence to antiretroviral treatment in Nepal

Wasti, Sharada Prasad (2012) Adherence to antiretroviral treatment in Nepal. PhD thesis, University of Sheffield.

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Abstract

Introduction Antiretroviral therapy (ART) is a lifesaver for individual patients treated for Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Maintaining optimal adherence (>95%) to ART is essential for HIV infection management. This study aims: a) to identify the proportion of patients who adhere to treatment; b) to understand the factors influencing adherence amongst ART-prescribed patients and care providers; and c) to explore what intervention strategies are likely to promote adherence to ART in Nepal. Methods A cross-sectional mixed-methods study was designed comprising a survey of 330 ART-prescribed patients and 34 in-depth interviews with three different stakeholders: 17 ART-prescribed patients, 14 care providers and three key policy level people. Adherence was assessed through self-report during the survey and patients were identified as having non-adherence if they missed even a single dose of their pills in last four-weeks prior to 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 282 (85.5%) of the respondents reported total adherence, i.e. no missed doses in the four-weeks prior to interview. Major factors influencing adherence in the multivariate analysis 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), time since ART started ≤24 months (OR=3.18, p= 0.009), time to travel 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, followed by pills running out, not wanting other people to notice, negative experience of side-effects, and being busy were the most common reasons for failure to take ART. The in-depth interviews also revealed religious or ritual obstacles, stigma, and discrimination, ART associated costs, transport problems, lack of family support, and negative experience of side-effects were reported as contributing factors for non-adherence. Three sets of different interventions strategies were identified to improve adherence: (a) personal strategies; (b) socio-economic strategies; and (c) health-system strategies. Conclusion Improving adherence requires a supportive environment to help people to disclose their status to others, accessible treatment, arranging financial supports, clear instructions about treatment regimens and regimens tailored to individual patients’ lifestyles. Health-care providers should address some of the practical and cultural issues around ART medicine whilst policy-makers should develop appropriate social policy to promote adherence. No single strategy alone can maintain optimal adherence in Nepal. Multidisciplinary adherence intervention strategies should be tailored to ongoing support integrated into clinical care and addresses the socio-cultural and health-system related barriers and facilitate adherence because adherence is not a discrete event, it requires lifelong attention.

Item Type: Thesis (PhD)
Keywords: HIV⁄AIDS, Antiretroviral Theraphy, Adherence, Mixed-methods, Nepal
Academic Units: The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield)
Depositing User: Dr. Sharada Wasti
Date Deposited: 08 Oct 2012 14:51
Last Modified: 08 Aug 2013 08:49
URI: http://etheses.whiterose.ac.uk/id/eprint/2750

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