Measuring adherence to antiretroviral treatment and assessing factors affecting adherence in a state primary healthcare clinic, Mitchells Plain Community Health Centre

Abstract

Background: A need was identified to measure adherence levels to antiretroviral treatment (ART) in a resource-poor setting and to assess the impact on adherence to ART of partner disclosure, partner support, other support, and length of time between diagnosis and ART commencement.
Method: A retrospective case-control study was conducted and the information was obtained by means of a file audit. One hundred and ninety-nine participants were chosen based on the inclusion and exclusion criteria. Adherence for each patient was measured using a formula documented in a published study. For the comparison group, 82 cases (nonadherent patients) were matched for age and gender with 82 adherent controls.
Results: The mean adherence for the initial group of 199 participants was 80.1%. Disclosure to a partner and partner support were not found to affect adherence significantly. The time between human immunodeficiency virus (HIV) diagnosis and ART commencement was also not found to make a statistically significant difference to adherence. There appeared to be an association, though not statistically significant, between support from other sources than the partner and equal to or greater than 95% adherence (P = 0.0579).
Conclusion: It can be concluded that adherence is probably influenced by a wide variety of factors. More qualitative studies or larger samples are recommended for better assessment of the impact on adherence of partner support and acceptance of HIV. Approaches to partner disclosure prior to commencing ART should be reviewed. The mean adherence level of 80.1% is an indication that more work is urgently needed to improve adherence levels in state-run clinics in South Africa.

Keywords: adherence, antiretroviral treatment, measuring adherence, factors affecting adherence, primary health care