Factors Affecting Adherence to Antiretroviral Therapy
Abstract
The success of highly active antiretroviral therapy (HAART) for treating human immunodeficiency virus (HIV) disease depends on maintaining a high level of adherence. Non-adherence is associated with a poor short-term virological response and accelerates the development of drug-resistant HIV. The shift to combination therapies for treating HIV-infected individuals has increased the challenges of adherence for both patients and health-care providers. The cumulative number of people in April 2015 who were eligible for HAART but had not yet started the therapy at the Adam Malik Hospital in Medan City Indonesia was 1,669 out of 6,033 people (27.66%). The cumulative number of absentees and loss to follow-up at >3 months was 1,273 out of 4,364 people (29.17%) up to April 2015.This study was a cross-sectional investigation of the factors associated with adherence to antiretroviral consumption for HIV-infected individuals at the Adam Malik Hospital in 2015. The sample size was 65 people, using consecutive sampling. The data were collected from medical records, observations, and an interview with a questionnaire. The data analysis included descriptive study, the chi-square test, Fisher’s exact test, and logistic regression, using STATA software. The results showed pill adherence in 28 patients (43.08%) and non-adherence in 37 patients (56.92%). The principal factors associated with non-adherence in the logistic regression were patient-related, including occupation (p = 0.062; OR = 0.22) and pill burden (p = 0.080; OR = 6.20). However, another factor that may have contributed was the system of health insurance (p = 0.015; OR = 5.00). The probability of the meaningful factors, based on the results of a multivariate analysis using the logistic function formula, is 0.7365 or 73.65%. The major reasons of HIV-infected individuals for not taking their medications were being employed, pill burden consideration, and without health insurance. Improving adherence probably requires the provision of the easy health insurance system with adequate patient preparation, innovative interventions and must fit into the socio cultural context of each setting.
Keywords: adherence, antiretroviral, health insurance, occupation, pill burden
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