Self-reported adverse effects as barriers to adherence to antiretroviral therapy in HIV-infected patients in Pretoria
Background: Adherence is the key to the effectiveness of antiretroviral therapy. However, many factors have been identified as facilitating or hamper- ing adherence. The aim of this study was to determine barriers and facilitators of adherence with particular emphasis on adverse effects. Methods: A survey of patients, who started antiretroviral treatment between July 2004 and August 2005, was conducted by means of a semi-struc-tured questionnaire. Those who consented to participate were interviewed for the collection of information on sociodemographic characteristics and clinical and other data. Results: The 180 patients who participated had a mean age of 36.7 (±8.1); 68.8% were female, 86.7% unemployed, 73.9% had a high school level of education, and 77.8% were single. Some 8.9% of the respondents used at least one non-prescribed medicine, while 34.4% received disability grants. Overall, 94% of the respondents reported at least one side effect; the mean number of self-reported side effects was 2.6 (± 1.4). With regard to adherence, the mean number of doses missed during the last seven days prior to the interview was 2.7 (±3.9), ranging from 0 to 18. The mean adherence level was 92.3%, ranging from 48.6% to 100.0%; overall, only 57.2% reported taking at least or over 95% of their prescribed doses. The two most common reasons for missing doses were forgetting (26.6%) followed by being away from home (15.6%). In the bivariate analysis, the only facilitator or factor that was significantly associated with at least or over 95% self-reported adherence was eating well (80.6% vs 64.5%; p = 0.025), whereas barriers or factors more likely and significantly associated with with self-reported adherence of at least or over 95% included having used non-prescribed medicines (15.6% vs 3.9%; p = 0.008), having suffered from headaches (28.6 vs 14.6%; p = 0.026) and reported symptoms such as insomnia (27.3% vs 12.6%; p = 0.013) and abdominal pain (20.8% vs 9.7%; p = 0.037). In the multivariate analysis, the facilitators or factors that were significantly associated with self-reported adherence of at least or over 95% were having an initial bodyweight of less than 50 kg (p = 0.026) and viral load of >33 000 copies /ml (p = 0.047). Conclusions: In conclusion, self-reported barriers to optimal adherence included the use of non-prescribed drugs, and the presence of side effects such as insomnia, headaches and abdominal pain; while eating well was a facilitator. These findings emphasise the need for better communication between patients and clinicians, and the need for integrating pharmacovigilance concepts in clinical practice.
South African Family Practice Vol. 50 (5) 2008: pp. 49-49b