Although evidence suggests adherence to antiretroviral therapy (ART) in African settings
is relatively high compared to North American settings, there are potentially high rates of
loss-to-follow up and little evidence-based information regarding facilitators and barriers
to adherence from developing countries yet majority of the people living with HIV and in
need of ART come from this region. This study explores factors that facilitate adherence
to ART medications among patients receiving antiretroviral medications from a clinic in
Nairobi, Kenya.
The study used methodological triangulation with a sample of 277 patients systematically
selected and interviewed using a structured questionnaire. A sub-sample of 22 patients
was further selected to participate in the semi-structured interviews and a focus group
discussion was conducted with 9 health care providers. Patients’ adherence levels were
determined using monthly pharmacy pill counts and a multivariate regression model was
used to determine predictors of adherence.
Out of the 277 respondents interviewed 72% (200) were female and 28% (77) were male.
The median age of the respondents was 35 years and 91% (228) of the patients on ART
achieved perfect adherence (>95%). Level of income (p-value 0.023 and odds ratio
4.093) and use of memory aids (p-value 0.016 and odds ratio 4.864) predicted optimal
adherence. Five factors emerged to explain optimal adherence: 1) improved health status
after ART initiation; 2) faith in the drugs (patients referred to drugs as food or life)
resulting in making drug taking part of their daily routine; 3) having dreams to
accomplish and meet family obligations; 4) support from others such as treatment
buddies, health care providers and support groups and 5) use of reminder tools.
Level of adherence using pharmacy pill count was high, with 91% of the patients
achieving perfect adherence of 95% and above. Adherence to treatment requires team
work between patients, health care providers and policy makers. Although adherence was

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high in this group, it can further be improved. At the individual level, patients need to
assess the motivators and barriers to adherence. This will help them to develop positive
attitude towards adherence and deal with the barriers encountered. At the facility level,
the health care providers have the obligation to ensure high health literacy levels among
patients through intensive adherence counseling before and after ART initiation. At the
policy level, policy makers should review empirical research focusing on interventions to
improve adherence and come up with evidence-based recommendations to improve
adherence.