The efficiency of highly active antiretroviral therapy (HAART) for the human
immunodeficiency virus (HIV) is well established, but its effectiveness depends
particularly on the adherence of patients to the drugs. Adherence of 95% or greater to
antiretroviral drugs is generally considered necessary to achieve optimal virologic
suppression in HIV-infected patients. While Kenya has rolled out ART access programs,
data on adherence to ART is limited especially considering that new cases of HIV have
continued to increase recently. Understanding factors associated with poor adherence is
essential to improve patient compliance, maximize virologic suppression, and reduce
morbidity and mortality. The main objective of this study therefore was to determine
factors associated with non-adherence among adult HIV patients attending the AmrefKibra
community based health centre in Nairobi, Kenya. Structured questionnaires were
administered to 280 study participants. Data on CD4 cell count before ART initiation
was obtained from patients’ health records. Non-adherence to ART was determined by
the CASE adherence tool in which patient’s scores were summed up to obtain a
composite score that ranged from 3 to 16 points. Patients with Index score≤ 10 points
were classified as non-adherent and> 10 adherent. Other data generated from the
questionnaire were keyed into SPSS and analyzed for frequencies, cross-tabulations, and
chi-square test. Multivariate logistic regression was done to determine the relationship
between the independent variables and the dependent variable of the study. Prevalence
of non adherence was 18%. Factors that were significantly associated with non
adherence include; forgetfulness (19%), side effects (17.5%), pill burden (15.7%), and
lack of disclosure (14.6%). Results on CD4 cell count showed that 9.9% of patients with
CD4 cell count < 250 exhibited ART non-adherence compared to 8% of the patients
with CD4 cell count>250. From multivariate logistic regression analysis the study also
showed that inadequate knowledge about the role of ART in HIV management, poor
attitudes and practices are associated with non-adherence. In conclusion, factors that
were significantly associated with non-adherence in this study were patient related.
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Forgetfulness was the most common reasons for non-adherence to ART. Therefore,
adherence counseling and health information dissemination need to include strategies to
minimize forgetfulness using memory aids such as pill boxes and written schedule.
Patients should also be informed about the side effects that they are most likely to
experience based on the ART regimen they have been put on. A simplified regimen
such as two pills once or twice daily should be considered to reduce non-adherence
cases associated with pill burden. There is need to develop skill to maintain adherence in
the non-disclosure state or design a way to encourage for disclosure. In addition, further
studies on adherence rate and its determinants with multiple adherence measurements to
resolve the barriers to non-adherence are also recommended. Initiating ART for
individuals as soon as they become eligible is important for success of ART program.