Non-adherence is a global problem and has been seen in all diseases. According to WHO, adherence to long-term therapies in chronic illnesses averages 50% in developed countries? Adherence to HAART is challenging, because patients need almost perfect adherence of at least 95 percent to keep viral load at undetectable levels as long as possible and maintain the functionality of the immune system. Poor adherence to antiretroviral therapy increases the risk of incomplete viral suppression, disease progression and death. The purpose of this study was to assess the level and factors associated with non-adherence to antiretroviral therapy. A random sample of 368 patients were taken from the ART clinic at Yirgalem Regional Hospital from September 2006 to July 2011.Adherence levels were measured using methods pill count, pill identification test, and self-report. Descriptive statistics and both Bivariate and multivariate Logistic Regression were used to analyzed the data. Homogeneous Semi-Markov Stochastic Model was used to reveal the conditional probability of staying in non-adherence. The Multivariate Logistic Regression Method showed that the gender (sex), family size, social support available to the patients, ART knowledge of the patients, time on ART in month, and baseline CD4 counts/mm3 were significant factors associated with non-adherence to ART medications. The conditional probability of staying in non-adherence, until a given time in month was higher than staying in adherence. Thus, it is suggested that health-care providers need to be watchful about adherence levels of patients. Specifically males, who have been on ART for several months, living in large family members, lack of social support, having high baseline CD4 counts/mm3, and having poor knowledge of ART.
ZAI conceived and designed the study. He also wrote the paper. AT contributed in the design, conduct and write-up of the paper. He also approved the manuscript. TTT, HTA and CMA contributed in the conduct and analysis of the study. Also, they prepared the manuscript. All of the authors have read and approved the manuscript.
UNAIDS/ WHO, "Global estimates of HIV as of end of 2001," 2001.
Ministry of Health, "Disease prevention & control department," Single Point HIV Prevalence Estimate, MOH, 2007.
The Federal Democratic Republic of Ethiopia, Guidelines for the implementation of antiretroviral therapy. Addis Ababa, Ethiopia, 2005.
A. Mocroft, "Changing patterns of mortality across Europe in patients infected with HIV-1," Lancet, vol. 352, pp. 1725–1730, 1998.
D. S. Paterson, "Adherence to protease inhibitor therapy and outcomes in patients with HIV infection," Ann Intern Med [Pubmed: 10877736], vol. 133, pp. 21–30, 2000.
M. Zaccarelli, "Multiple drug class-wide resistance associated with poorer survival after treatment failure in a cohort of hiv-infected patients," AIDS, vol. 19, pp. 1081–1089, 2005.
J. Bartlett and M. Fathr.Demasi, "An updated systematic overview of triple combination therapy in antiretroviral-naive HIV-infected adults," AIDS [Pubmed: 17053351], vol. 20, pp. 2051–64, 2006.
S. Deeks, Factors associated with failure to achieve viral suppression. 37pthp ICAAC, Canada: Toronto, Abstract, 1997.
F. L. Altice and G. H. Friedland, "The era of adherence to HIV therapy," Ann. Intern. Med., vol. 129, pp. 503-505, 1998.
E. J. Mills, J. bnachegad, and R. Bangsberg, "Adherence to antiretroviral therapy in Sub-Saharan Africa and North America," Journal of America Medical Association, vol. 296, pp. 679-90, 2006.
M. D. Stein and J. D. R. Makad, "Adherence to antiretroviral therapy among HIV-infected methadone patients: Effect of ongoing illicit drug use," Am J Drug Alcohol Abuse, vol. 26, pp. 195-205, 2000.
M. A. Chesney, "Factors affecting adherence to antiretroviral therapy," Clin Infect Dis., vol. 30, pp. S171-S76, 2000.
Y. Tadios and G. Davey, "Retroviral drug adherence & its correlates in Addis Ababa, Ethiopia," Ethiop Med J., vol. 44, pp. 237-244, 2006.
A. Mengesha and A. Worku, "Assessment of antiretroviral treatment among HIV infected persons in the ministry of defense hospitals," 2005.
M. Endrias and G. W. Alemayehud, Adherence to ART in PLWHA at yirgalem hospital. South Ethiopia, 2006.
Dahab, "Contrasting predictors of poor antiretroviral therapy outcomes in two South African HIV programmes," A Cohort Study BMC Public Health, vol. 10, p. 430, 2010.
R. H. Haubrich, S. J. Little, and J. S. Currier, "The value of patient reported adherence to antiretroviral therapy in predicting virologic and immunologic response," California Collaborative Treatment Group. AIDS, vol. 13, pp. 1099-1107, 1999.
S. L. Catz, J. A. Kelly, L. M. Bogart, E. G. Benotsch, and T. L. Mcauliffe, "Patterns, correlates, and barriers to medication adherence among persons prescribed new treatments for HIV disease," Health Psychology, vol. 19, pp. 124–133, 2000.
V. Gordillo, J. D. Amo, V. Soriano, and J. Gonzalez-Lahoz, "Sociodemographic and psychological variables influencing adherence to antiretroviral therapy," AIDS, vol. 13, pp. 1763–1769, 1999.
W. Holzemer, I. Corless, K. Nokes, J. Turner, M. Brown, and G. Powell-Cope, "Predictors of self-reported adherence in persons living with HIV disease," AIDS Patient Care and Stds, vol. 13, pp. 185–197, 1999.
F. Motashari, "Acceptance and adherence with HAART therapy among HIV infected women in a correctional facility," Journal of Acquired Immune Deficiency Syndromes and Human Retrovirology, vol. 18, pp. 341-348, 1998.
N. Singh, S. M. Berman, S. Swindells, J. C. Justis, J. A. Mohr, C. Squier, and M. M. Wagener, "Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy," Clinical Infectious Disease, vol. 29, pp. 824–830, 1999.
B. Seid, Statistical analysis of determinants of non-adherence to antiretroviral treatment and its effect on immunological recovery: A case study at. Ethiopia: Hawassa Referral Hospital, 2011.
A. Williams and G. Friedland, "Adherence and HAART at AIDS clinical care," vol. 9, p. 51 55, 1997.
N. Wenger, "Patient characteristics and attitudes associated with HAART adherence," 1999.
M. C. F. Silva, R. A. A. Ximenes, D. B. Miranda Filho, L. W. M. S. Arraes, M. Mendes, A. C. S. Melo, and P. R. M. Fernandes, "Risk-factors for non-adherence to antiretroviral therapy," Rev. Inst. Med. Trop. S. Paulo, vol. 51, pp. 135-139, 2009.
M. Charurat, M. Oyegunle, R. Benjamin, A. Habib, and E. Eze, "Patient retention and adherence to antiretrovirals in a large antiretroviral therapy program in Nigeria: A longitudinal analysis for risk factors," Plos ONE, vol. 5, p. e10584, 2010.