Determinants of poor adherence to antiretroviral treatment using a combined effect of age and education among human immunodeficiency virus infected young adults attending care at Letaba Hospital HIV Clinic, Limpopo Province, South Africa

Abstract

Introduction: sustained viral suppression using antiretroviral treatment (ART) occurs with adherence to treatment of at least 95%. Non-adherence promotes the development of drug-resistance and treatment failure in individuals infected with Human Immunodeficiency Virus. In Limpopo Province, the adherence rate is approximately 61%, but the prevalence and the factors associated with adherence at Letaba hospital HIV clinic are not well established. Therefore, the aim of this study was to identify the factors associated with adherence among HIV-infected young adults, aged 18-35 years, attending the clinic.

Methods: a cross-sectional survey was conducted in Letaba HIV clinic among young adults of 18-35 years old. Logistic regression analysis was performed to determine factors associated with ART adherence. We reported odds ratios with the corresponding 95% confidence intervals and p-values. A p-value < 0.1 was considered as statistically significant. ART adherence was defined as taking more than 95% of the prescribed treatment, 3 days prior to completion of the questionnaire.

Results: a total of 281 participants were enrolled with 163 (58.0%) females and more than three quarter, 222 (79.0%) between the ages of 18 and 29 years. The overall ART adherence stood at (87.2%) (95% CI: 63.0%-89.0%) representing 245 participants. Non-adherers to treatment, 36 (12.8%): patients reported no reason (3.9%), forgetting (3.2%), feeling good (3.2%), fear and running out of treatment (2.5%) as some of the reasons for not taking treatment within the three days prior to data collection. The following factors: tertiary education (p = 0.07), age (30-35; p-value: 0.07), drug availability (p-value: 0.07), were only marginally significantly associated with ART adherence.

Conclusion: the study found unsatisfactory ART adherence among our participants. Our study suggests that factors other than sociodemographic and clinical factors might better explain differences in adherence. This highlights the need for a more complex study that would look at the entire system in which these patients are navigating as well as their mental models.