Adherence to highly active antiretroviral therapy among patients in the Keetmanshoop antiretroviral therapy programme, Namibia

Type Thesis or Dissertation - Master in Public Health
Title Adherence to highly active antiretroviral therapy among patients in the Keetmanshoop antiretroviral therapy programme, Namibia
Publication (Day/Month/Year) 2010
The government of Namibia established a comprehensive HIV/AIDS treatment and care
programme in 2002. This programme provides anti-retroviral treatment to all eligible HIV
patients in the public health sector. The antiretroviral treatment programme in Keetmanshoop
started in October 2003. Adherence to treatment regimes in HIV care is a key factor in
determining clinical outcomes and is associated with improved survival among HIV and
AIDS patients. Sustained high levels of adherence (95% or more) are essential for the success
of highly active antiretroviral therapy (HAART). Maintaining high adherence levels is
therefore a major concern in HIV/AIDS treatment programmes. This study investigated
adherence to HAART among patients in the Keetmanshoop antiretroviral therapy (ART)
clinic and the factors that affect adherence.
Aim of the research
The aim of the research was to describe adherence to HAART and factors influencing
adherence among patients in Keetmanshoop ART clinic, Namibia.
1. To describe levels of adherence to HAART amongst clients at Keetmanshoop ART clinic.
2. To assess the changes in CD4 count and body weight of clients on HAART over a 12
month period.
3. To assess factors associated with adherence to HAART.
4. To analyse associations between CD4 count and adherence.
5. To analyse associations between changes in body weight and adherence.
A quantitative descriptive cross-sectional survey was used. The study population included all
clients 18 years and above, who were on HAART for one year or more at the Keetmanshoop
clinic. One hundred and six clients participated in the study. Data was collected through an
interview with the participants and a review of clinical records.
Most respondents had good adherence levels; with 86.1% reporting optimal adherence levels.
The respondents also showed an increase of median CD4 counts from 126 cells/µl at baseline
to 304 cells/µl at 12 months and an increase in body weight from an average of 50kg at
baseline to an average of 57kg at 12 months. Adherence levels were found to have an impact
on CD4 cell counts and on body weight, with respondents who had sub-optimal adherence
experiencing a drop in median CD4 cell counts and median body weight by 12 months.
Living far from the clinic (>10km) was found to be the only factor significantly associated
with sub-optimal adherence.
The study showed a positive correlation between adherence levels and CD4 cell counts and
body weight gain. In the absence of viral load, CD4 cell count testing can be used as a
measure of adherence. Though most respondents appear to be adhering well to HAART, a
sub-optimal adherence rate of >10% is a concern for the Keetmanshoop ART programme and
will need to be addressed. There is a need for further research to determine the level of
default or attrition from HAART in the programme.

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