The Level of Art Adherence Among Hiv and Aids Patients Attending Kilembe Mines Hospital Art-Clinic, Kasese District

Table of Contents 

DECLARATION ........................................................................................................................................... ; 

APPROVAL .................................................................................................................................................. ii 

DEDICATION ............................................................................................................................................. iii 

ACKNOWLEGEMENT .............................................................................................................................. iv 

List of tables ................................................................................................................................................. ix 

List of figures ................................................................................................................................................ x 

DEFINITION OF CONCEPTS .................................................................................................................... xi 

ABBREVIATIONS ..................................................................................................................................... xii 

ABSTRACT ............................................................................................................................................... xiii 

CHAPTER ONE ........................................................................................................................................... 1 

INTRODUCTION ......................................................................................................................................... 1 

1.1 Background ....................................................................................................................................... 1 

1.2 Problem Statement ............................................................................................................................ 2 

1.3 Objectives .......................................................................................................................................... 2 

1.3.1 Main Objectives ........................................................................................................................ 2 

1.3.2 Specific Objectives .................................................................................................................... 2 

1.4 Research Questions ........................................................................................................................... 3 

1.5 Justification ....................................................................................................................................... 3 

1.6 Scope of the study ............................................................................................................................. 3 

1.6.1 Time Scope ................................................................................................................................ 3 

1.6.2 Geographical Scope ................................................................................................................... 3 

1.6.3 Content Scope ............................................................................................................................ 3 

I. 7 Conceptual frame work ..................................................................................................................... 4 

CHAPTER TW0 ........................................................................................................................................... 5 

LITERATURE REVIEW .............................................................................................................................. 5 

2.1 ART adherence .................................................................................................................................. 5 

2.2 Measurements of the levels of ART adherence ................................................................................. 5 

2.2.1 Biological assays ....................................................................................................................... 5 

2.2.2 Pill counts .................................................................................................................................. 5 

2.2.3 Electronic monitoring/medication event monitoring system (MEMS) ..................................... 5 

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2.2.4 

2.2.5 

2.2.6 

2.3 

2.3.1 

Pharmacy records ...................................................................................................................... 6 

Self- reporting ............................................................................................................................ 6 

Direct observed therapy (DOT) ................................................................................................. 6 

Factors associated with ART adherence ............................................................................................ 6 

Demographic, Culture, Religious and family-related factors .................................................... 6 

2.3.1.1 Demographic factors ................................................................................................................. 6 

2.3.1.2 Family related factors ................................................................................................................ 6 

2.3 .1.3 Cultural beliefs .......................................................................................................................... 6 

2.3.1.4 Religious beliefs ........................................................................................................................ 7 

2.3.2 Patient factors ............................................................................................................................ 7 

2.3.4 Health system factors ................................................................................................................ 7 

2.3.5 Socio-economic factors ............................................................................................................. 7 

2.3.6 Work place factors ..................................................................................................................... ? 

2.3.7 Treatment related factors ........................................................................................................... ? 

2.3. 7.1 Side-effects ............................................................................................................................... 7 

2.3.7.2 Treatment fatigue ........................................................................................................................ 8 

CHAPTER THREE ....................................................................................................................................... 9 

METHODOLOGY ........................................................................................................................................ 9 

3.1 Study design ...................................................................................................................................... 9 

3.2 Study area .......................................................................................................................................... 9 

3.3 Study population ............................................................................................................................... 9 

3.4 Sampling method ................................................................................................................................... 9 

3.5 Sample size determination ................................................................................................................. 9 

3.6 Inclusion and exclusion criteria ....................................................................................................... 10 

3 .6.1 Inclusion criteria ........................................................................................................................... 10 

3.6.2 Exclusion Criteria .................................................................................................................... 10 

3.7 Data collection ................................................................................................................................. 10 

3.8 Data quality control ......................................................................................................................... 10 

3.9 Data analysis ................................................................................................................................... 10 

3.10 Ethical considerations ...................................................................................................................... 10 

3 .11 Study limitations ............................................................................................................................. 11 

CHAPTER FOUR ....................................................................................................................................... 12 

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RESULTS .................................................................................................................................................... 12 

4.1 Demographic and socio-economic characteristics association with ART adherence ..................... 12 

4.2 Factors associated with ART adherence .......................................................................................... 14 

4.2.1 Family factors .......................................................................................................................... 14 

4.2.1.1 Treatment by family members .................................................................................................... 14 

4.2.3 Treatment related factors (Reasons for difficulty to take medicine) ....................................... 14 

4.2.4 Patient factors .......................................................................................................................... 15 

4.2.5 Health system related factors ................................................................................................... 16 

4.2.5.1 Time taken to reach the hospital... ............................................................................................... 16 

4.2.5 .2 Easiness for patients to come to the health facility for their appointments ............................. 16 

4.2.5.3 Rating the services of the health workers at the ART Clinic ...................................................... 16 

4.2.5.4 Privacy during consultations and counseling at the ART Clinic ................................................... 17 

4.2.5.5 Participants ever run out of tablets (ART medication) ............................................................ 17 

4.3 Level of Adherence ......................................................................................................................... 18 

4.3.1 Self-Report ..................................................................................................................................... 18 

4.3.2 Pill Count. ................................................................................................................................ 18 

4.3.3 Phannacy Refill ....................................................................................................................... 19 

CHAPTER FIVE ......................................................................................................................................... 20 

DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS ............................................................ 20 

5. I DISCUSSION ................................................................................................................................. 20 

5.1.1 Social demographic factors ..................................................................................................... 20 

5.1.2 Factors affecting ART adherence ................................................................................................... 21 

5.1.2.1 Family and community treatment factors ................................................................................ 21 

5.1.2.2 Treatment factors ..................................................................................................................... 21 

5.1.2.3 Patient factors .......................................................................................................................... 21 

5.1.2.4 Health service factors .............................................................................................................. 22 

5.1.3 Levels of ART adherence ........................................................................................................ 22 

5.2 CONCLUSIONS ............................................................................................................................. 23 

5.3 RECCOMEDATIONS .................................................................................................................... 23 

Appendices .................................................................................................................................................. 27 

Appendix i: Study Questionnaire ................................................................................................................ 27 

Appendix ii: Consent Form .................................................................................................................. 31 

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Appendix iii: Map ofKasese District showing location ofKilembe Mines Hospital.. ............................... 32 

Appendix iv :Approval Letter For Data Collection ................................................................................... 33 

ABSTRACT

Background: Introduction and adopted use of ART has shown reduction in HIV related mortality and morbidity in people with HIV/AIDS. However high levels of ART adherence (>95%) is required to achieve effective suppression of viral load among patients.

Objective: The study was aimed at determining the level of ART adherence and the associated factors among HIV/AIDS patients attending Kilembe mines hospital in Kasese District.

Methods: A cross-sectional descriptive stndy design was used to obtain qualitative data using a structured questionnaire administered to participants. Systematic random sampling was used to obtain 109 study participants attending Kilembe Mines Hospital. The data analyzed was presented using frequency tables.

Results: The results indicated that the adherence to ART by patients at the Kilembe Hospital ART Clinic was 70%. This level of adherence was associated with several factors including stigmatization, distance to health facility, gender discrimination and side effects arising from ART.

Conclusion: The observed level of ART adherence was70% associated with patient, treatment and health system factors. Continuous community health education and campaigns against stigma and gender discrimination will improve ART adherence among HIV patients.