The introduction of highly active antiretroviral therapy (HAART) has led to a significant
reduction in Acquired Immunodeficiency Syndrome (AIDS)-related morbidity and
mortality.
Adverse drug reactions are a commonly cited cause of poor adherence to HAART.
The short-term adverse effects are potential threats to successful introduction and
maintenance of HAART, while long term adverse effects can threaten sustenance of long
term treatment. Although the association of side effects with adherence behavior seems
intuitive, few studies have addressed this issue specifically. The objectives of this cross
sectional descriptive study were to assess the level of adherence to HAART; variables
predictive of sub-optimal adherence; medication side effects associated with HAART, and
their association with adherence. Interviewer-administered questionnaires were used to
assess adherence in the past 3 days (short term) and past one month (long term). The
questionnaire also assessed the type and perceived intensity of 13 common HAARTrelated
symptoms experienced during the last one month, and how these had affected the
participant’s adherence to HAART.
Data analysis was done using SPSS 17.0. Summaries were made for; HAART
related side effects, regimen characteristics, patient factors and socio demographic
characteristics. Short term (3 day) adherence and long term (1 month) adherence were
categorized at the 95% level as adherent, (taking 95% or more of the prescribed drugs), or
non-adherent (taking less than 95% of the prescribed drugs). Logistic regression was used
to determine the factors significantly associated with adherence. Chi square tests were
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used to assess association between adherence and number and perceived intensity of side
effects.
A total of 183 patients were interviewed; 67.8% female and 32.2% male. The
mean age was 39.2 years (±9.4) and 64.5% had been on treatment for over 13 months.
Mean 3 day adherence was 96.4% (+/- 14.5) while mean 1 month adherence was 98.1%
(+/-9.2). The most common reasons for missing medications were running out of drugs
(11%) and being away from home (8.7%). During the preceding one month, 30.6% of
patients had experienced at least one medication side effect. The most commonly reported
side effects were; tiredness/general malaise (20.6%), rash (19.8), dizziness (17.5), nausea
and vomiting (15.9%), stomach upsets (15.9%), sleepiness (15.9%) and headache
20(15.9%). Only 14.2% of patients who experienced side effects reported that they
influenced their medication taking in some way. Among these, only 5.4% stopped taking
their medications as a result. Side effects were neither associated with short term
adherence (OR 1.98 P-value 0.13); nor long term adherence (OR 1.01 P-value 0.97). The
last time a patient missed medication predicted long term adherence (OR, 1.7; P=0.03).
Other patient factors and regimen characteristics were not found to predict adherence to
HAART. The duration a patient had been on treatment was significantly associated with
the number of side effects (Chi-square p-value 0.04); patients who had been on treatment
for longer had more side effects than those who had been on treatment for a shorter
period.
These results show that HAART patients in Tigoni had optimal of over 95%.
Those who had a gap in taking medication during the preceding 2 weeks were more likely
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to be non-adherent. General Malaise, Rash, Dizziness, Nausea and Vomiting, Stomach
Upsets, Sleepiness and Headache were side effects that were commonly experienced in
this setting. However, side effects did not significantly affect adherence.