Factors associated with ART non-adherence and contributing influence of stock shortages at Nkongsamba Regional Hospital, Cameroon

Thesis (Master's)--University of Washington, 2015Background Antiretroviral therapy (ART) requires a high level of adherence for treatment success and viral suppression. Studies from Cameroon's capital report low levels of adherence and have identified multiple factors associated with non-adherence. This study described adherence to ART among HIV-infected patients receiving treatment at Nkongsamba Regional Hospital, and identified factors associated with non-adherence. This study also investigated the impact of stock shortages on the lives of patients. Methods This is a cross-sectional study conducted at Nkongsamba Regional Hospital's HIV center. Patients receiving ART aged over 21 years were randomly selected and interviewed using a mixed-methods questionnaire about their experience taking ART and their experience with stock shortages. Additional longitudinal data was extracted from HIV center records. Participants were grouped into adherent and non-adherent based on a composite score derived from a three questions tool developed by the Center for Adherence Support Evaluation (CASE). Pearson's chi-square tests and independent samples t-tests were performed to identify factors associated with adherence. Results 201 patients were interviewed using the mixed-methods questionnaire. 127 (62.2%) were classified as adherent to ART and 76 (37.8%) classified as non-adherent according to the CASE index of adherence determination. Women were significantly more likely than men to report poor adherence to ART (p=. 08). Married and widowed respondents were significantly more likely than those who were single, divorced or living with a partner to report good adherence to ART (p=.08). There was no association found between stock shortages of ART and adherence (p=.56). Responses to the open-ended questions revealed financial, psychological, and physiological adverse effects of stock shortages. Coping strategies related to religion, antibiotic use, stockpiling medication, calling ahead to the hospital, good nutrition, and good psychological health were reported to mitigate the adverse effects of stock shortages. Conclusion Non-adherence to ART remains unacceptably high in this population. Stock shortages of ART were not found to be significantly associated with non-adherence; however, the supplementary longitudinal and qualitative data suggests that stock shortages do have a negative impact on other aspects of patients' lives.