Factors that constrain adherence to antiretroviral therapy among HIV positive patients in the Sekondi-Takoradi Metropolis

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Background: The lack of adherence to antiretroviral therapy (ART) is a major challenge to HIV care and has serious public health implications as it can accelerate the emergence of drug resistant strains of HIV. As Ghana scales up access to ART in all health facilities, there is the need to estimate the level of adherence and understand the factors that prevent adherence in order to design appropriate interventions. Method: A total of 426 HIV positive adult patients on ART were interviewed using structured questionnaire. Adherence rate was estimated using the patient self-report assessment of adherence. Data was analysed using SPSS for frequencies, cross-tabulations and Chi-Square tests using a statistical significance set at p<0.05. Variables found to be statistically significant under univariate analysis were subjected to multivariate logistic regression analysis. Odds ratio (OR) and its 95% confidence interval (CI) were computed. Results: The optimal adherence level was 67%. Thirty seven percent (37%) of the respondents had missed at least one clinic appointment in the last six months. Three variables remained significant using logistic regression. These included forgetfulness (Adjusted OR=5.76; 3.89-8.59) being away from home (Adjusted OR=5.49; 3.76-8.02) and missing clinic appointment (Adjusted OR=1.78; 1.65-1.91). Conclusion: Patients who miss clinic appointment should be monitored, the reasons behind the missed appointment investigated and appropriate support given. Patients who miss a dose because of forgetfulness should be educated on the use of prompters such as mobile phone alarm and text messages. Patients should also be encouraged to carry their ARVs on them when they are away from home.
A thesis submitted to the Department of Health Promotion and Education, College of Health Sciences, School of Public Health, in partial fulfilment of requirements for the degree of Master of Public Health in Health Promotion and Education.