Table of Contents
DECLARATION ........................................................................................................................................... ;
APPROVAL .................................................................................................................................................. ii
DEDICATION ............................................................................................................................................. iii
ACKNOWLEGEMENT .............................................................................................................................. iv
List of tables ................................................................................................................................................. ix
List of figures ................................................................................................................................................ x
DEFINITION OF CONCEPTS .................................................................................................................... xi
ABBREVIATIONS ..................................................................................................................................... xii
ABSTRACT ............................................................................................................................................... xiii
CHAPTER ONE ........................................................................................................................................... 1
INTRODUCTION ......................................................................................................................................... 1
1.1 Background ....................................................................................................................................... 1
1.2 Problem Statement ............................................................................................................................ 2
1.3 Objectives .......................................................................................................................................... 2
1.3.1 Main Objectives ........................................................................................................................ 2
1.3.2 Specific Objectives .................................................................................................................... 2
1.4 Research Questions ........................................................................................................................... 3
1.5 Justification ....................................................................................................................................... 3
1.6 Scope of the study ............................................................................................................................. 3
1.6.1 Time Scope ................................................................................................................................ 3
1.6.2 Geographical Scope ................................................................................................................... 3
1.6.3 Content Scope ............................................................................................................................ 3
I. 7 Conceptual frame work ..................................................................................................................... 4
CHAPTER TW0 ........................................................................................................................................... 5
LITERATURE REVIEW .............................................................................................................................. 5
2.1 ART adherence .................................................................................................................................. 5
2.2 Measurements of the levels of ART adherence ................................................................................. 5
2.2.1 Biological assays ....................................................................................................................... 5
2.2.2 Pill counts .................................................................................................................................. 5
2.2.3 Electronic monitoring/medication event monitoring system (MEMS) ..................................... 5
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2.2.4
2.2.5
2.2.6
2.3
2.3.1
Pharmacy records ...................................................................................................................... 6
Self- reporting ............................................................................................................................ 6
Direct observed therapy (DOT) ................................................................................................. 6
Factors associated with ART adherence ............................................................................................ 6
Demographic, Culture, Religious and family-related factors .................................................... 6
2.3.1.1 Demographic factors ................................................................................................................. 6
2.3.1.2 Family related factors ................................................................................................................ 6
2.3 .1.3 Cultural beliefs .......................................................................................................................... 6
2.3.1.4 Religious beliefs ........................................................................................................................ 7
2.3.2 Patient factors ............................................................................................................................ 7
2.3.4 Health system factors ................................................................................................................ 7
2.3.5 Socio-economic factors ............................................................................................................. 7
2.3.6 Work place factors ..................................................................................................................... ?
2.3.7 Treatment related factors ........................................................................................................... ?
2.3. 7.1 Side-effects ............................................................................................................................... 7
2.3.7.2 Treatment fatigue ........................................................................................................................ 8
CHAPTER THREE ....................................................................................................................................... 9
METHODOLOGY ........................................................................................................................................ 9
3.1 Study design ...................................................................................................................................... 9
3.2 Study area .......................................................................................................................................... 9
3.3 Study population ............................................................................................................................... 9
3.4 Sampling method ................................................................................................................................... 9
3.5 Sample size determination ................................................................................................................. 9
3.6 Inclusion and exclusion criteria ....................................................................................................... 10
3 .6.1 Inclusion criteria ........................................................................................................................... 10
3.6.2 Exclusion Criteria .................................................................................................................... 10
3.7 Data collection ................................................................................................................................. 10
3.8 Data quality control ......................................................................................................................... 10
3.9 Data analysis ................................................................................................................................... 10
3.10 Ethical considerations ...................................................................................................................... 10
3 .11 Study limitations ............................................................................................................................. 11
CHAPTER FOUR ....................................................................................................................................... 12
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RESULTS .................................................................................................................................................... 12
4.1 Demographic and socio-economic characteristics association with ART adherence ..................... 12
4.2 Factors associated with ART adherence .......................................................................................... 14
4.2.1 Family factors .......................................................................................................................... 14
4.2.1.1 Treatment by family members .................................................................................................... 14
4.2.3 Treatment related factors (Reasons for difficulty to take medicine) ....................................... 14
4.2.4 Patient factors .......................................................................................................................... 15
4.2.5 Health system related factors ................................................................................................... 16
4.2.5.1 Time taken to reach the hospital... ............................................................................................... 16
4.2.5 .2 Easiness for patients to come to the health facility for their appointments ............................. 16
4.2.5.3 Rating the services of the health workers at the ART Clinic ...................................................... 16
4.2.5.4 Privacy during consultations and counseling at the ART Clinic ................................................... 17
4.2.5.5 Participants ever run out of tablets (ART medication) ............................................................ 17
4.3 Level of Adherence ......................................................................................................................... 18
4.3.1 Self-Report ..................................................................................................................................... 18
4.3.2 Pill Count. ................................................................................................................................ 18
4.3.3 Phannacy Refill ....................................................................................................................... 19
CHAPTER FIVE ......................................................................................................................................... 20
DISCUSSION, CONCLUSIONS AND RECOMMENDATIONS ............................................................ 20
5. I DISCUSSION ................................................................................................................................. 20
5.1.1 Social demographic factors ..................................................................................................... 20
5.1.2 Factors affecting ART adherence ................................................................................................... 21
5.1.2.1 Family and community treatment factors ................................................................................ 21
5.1.2.2 Treatment factors ..................................................................................................................... 21
5.1.2.3 Patient factors .......................................................................................................................... 21
5.1.2.4 Health service factors .............................................................................................................. 22
5.1.3 Levels of ART adherence ........................................................................................................ 22
5.2 CONCLUSIONS ............................................................................................................................. 23
5.3 RECCOMEDATIONS .................................................................................................................... 23
Appendices .................................................................................................................................................. 27
Appendix i: Study Questionnaire ................................................................................................................ 27
Appendix ii: Consent Form .................................................................................................................. 31
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Appendix iii: Map ofKasese District showing location ofKilembe Mines Hospital.. ............................... 32
Appendix iv :Approval Letter For Data Collection ................................................................................... 33
ABSTRACT
Background: Introduction and adopted use of ART has shown reduction in HIV related mortality and morbidity in people with HIV/AIDS. However high levels of ART adherence (>95%) is required to achieve effective suppression of viral load among patients.
Objective: The study was aimed at determining the level of ART adherence and the associated factors among HIV/AIDS patients attending Kilembe mines hospital in Kasese District.
Methods: A cross-sectional descriptive stndy design was used to obtain qualitative data using a structured questionnaire administered to participants. Systematic random sampling was used to obtain 109 study participants attending Kilembe Mines Hospital. The data analyzed was presented using frequency tables.
Results: The results indicated that the adherence to ART by patients at the Kilembe Hospital ART Clinic was 70%. This level of adherence was associated with several factors including stigmatization, distance to health facility, gender discrimination and side effects arising from ART.
Conclusion: The observed level of ART adherence was70% associated with patient, treatment and health system factors. Continuous community health education and campaigns against stigma and gender discrimination will improve ART adherence among HIV patients.
