Barriers to antiretroviral adherence in HIV-positive patients receiving free medication in Kayunga, Uganda
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Date
2011
Journal Title
Journal ISSN
Volume Title
Publisher
AIDS care
Abstract
Global and local efforts have been devoted to increase the supply of antiretroviral therapy (ART) in sub-Saharan
Africa. Recent qualitative studies suggest that even with free ART, patients may fail to adhere to medication
because of socioeconomic barriers such as transportation costs to clinics. The aim of this study was to measure
adherence in a population of patients receiving free ART and to examine barriers to adherence. Adherence was
measured using the pill count and self-report methods among 140 HIV-positive patients at four PEPFARfacilitated
ART clinics in Kayunga, a rural district in Uganda. Self-report was also used to examine reasons for
non-adherence. Pill count adherence estimates revealed that 86.4% of the patients were adherent (]95%) in the
past six months. Self-report estimates showed that all the patients were adherent in the past six months with
average adherence of 99.7%90.6. The main reasons for non-adherence were being away from medication at dose
time (29.4%) and forgetting to take pills (27.5%). Lack of access to food and transportation costs accounted for
11.7% and 7.8% of non-adherence, respectively. Patients with 100% adherence reported lack of access to food as
the main challenge they had to overcome to stay adherent. Patients attending the rural clinic were significantly
less adherent to ART than patients at the Kayunga district capital [OR 0.046 (0.008 0.269)]. The study revealed
that the greatest patient-perceived challenge to adherence in this population is the lack of access to food; however,
the immediate reasons for non-adherence were found to be forgetfulness and being away from medication at
dose’s time. These results suggest that interventions tackling lack of access to food are necessary, but
interventions addressing forgetfulness and being away from medication at dose’s time would be the most effective
in enhancing adherence inpatients receiving free ART.
Description
Keywords
HIV/AIDS, adherence, free ART, Uganda
Citation
Senkomago, V., Guwatudde, D., Breda, M., & Khoshnood, K. (2011). Barriers to antiretroviral adherence in HIV-positive patients receiving free medication in Kayunga, Uganda. AIDS care, 23(10), 1246-1253.DOI: 10.1080/09540121.2011.564112