Aim: To identify the factors associated with non-adherence to Antiretroviral Treatment (ART) amongst adult patients at a hospital in Namibia.
Methods: A quantitative and qualitative approaches were employed, study sample of 112 adults aged 21 years and older at Keetmanshoop District State Hospital participated. Adherence to ART was assessed using the pill count and self-report methods. A questionnaire with a Cronbach value of 0.8 was used. Census and multi-stage sampling was applied. Data was collected from August to September 2016 through structured interviews and patients records review. Correlation of variables was done to remove multicollinearity. Stata version 12 was used for logistic regression to do univariate and multivariate analysis to determine factors associated with missing five or more doses.
Results: In the univariate analysis the following factors were associated with missing five or more doses: Viral load OR: 5.6, 95%CI: 2.0- 16.0, Employment OR: 3.3, 95%CI: 1.5-7.2, Taking active substance OR: 2.5, 95%CI: 1.3-4.7 and Emotional status OR: 1.6, 95%CI: 1.02- 2.6. The ART stocks seemed adequate as the OR for out of stock did not lead to missed doses (OR: 0.6, 95%CI: 0.4-0.9). Factors such as gender, education, religion and marital status were not associated with missing five or more doses. After multivariate logistic regression the following factors were associated with missing five or more doses; Taking substance adjusted OR: 3.3, 95%CI: 1.4-7.6; WHO clinical stages 2 and 3 adjusted ORs and 95%CIs: 4.1 (1.2-13.8) and 6.1(1.5-25.1) respectively and viral load adjusted OR: 6.3, 95%CI: 2.1-18.7. Reasons mentioned by respondents for missed doses included forgetting, alcohol use, poor access to care, work commitments, lack of food, stress and travelling. Of the 112 respondents in the study, 86.6% had unsuppressed viral loads.
Conclusion: Recommendations includes reinforcing use of reminders, automated SMS, establishing treatment supporters and collaborative efforts in reducing active substance use to improve patient adherence.
Keywords: Adherence; Adult; Antiretroviral (ARV) treatment; Health Belief Model; Human Immuno-deficiency Virus (HIV); Non-adherence.