Examining The Relationship Between Program Support And Adherence To Highly Active Anti-Retroviral Therapy (Haart) In Kenya And Zambia: The Role Of Art Knowledge On This Relationship
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DepartmentPublic Health and Policy
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Highly Active Antiretroviral Therapy (HAART) adherence is critical to slowing down reproduction of the AIDS virus and ensuring viral load suppression in people living with the disease. Few studies have assessed how well comprehensive structured treatment programs eliminate disparities in treatment outcomes, and positively influence a person's ability to adhere to HAART. This cross-sectional study examined the effect of program support, patient knowledge about HIV and HAART, and patient physical and behavioral factors on adherence for patients in structured comprehensive AIDSRelief treatment programs in Kenya and Zambia. Complete adherence was measured as patient self-reporting of no missed doses in the last week and month, and no missed clinic appointments in the last three months for patients currently on treatment for at least nine months. Of the 1,418 adults (ages 15 years and older) 54.4% self-reported complete adherence to treatment. Unadjusted and adjusted models were developed to estimate adherence based on study indicators. After controlling for socio-demographic, risk behavior, clinical, and knowledge indicators, receiving high levels of program support (Adjusted Odds Ratio=1.58, Confidence Interval=1.17, 2.14; p=0.003), having high knowledge (Adjusted Odds Ratio=1.66, Confidence Interval=1.01, 2.73; p<0.05) were predictive of positive adherence. Disclosing HIV status to a spouse (Adjusted Odds Ratio=0.60, CI 0.43, 0.83; p=0.005) was predictive of low adherence. Gender, age, marital status, home ownership, months on therapy, CD4 level, sexual risk behaviors of disclosing to sex partners and condom usage were not predictive of adherence. To improve treatment adherence in developing countries, continuous emphasis on structured program support is an ideal model for strengthening the health safety net for individuals living with HIV/AIDS in these settings. Study findings indicate that the AIDSRelief program promotes adherence overall and eliminates age and gender disparities in treatment access in developing countries. Additionally, programs in resource limited settings should focus on issues that prevent spousal disclosure of HIV status by incorporating a married component into structured education and counseling sessions to educate couples about familial support during treatment. Such activities may sensitize married couples to the issue and promote familial support in these settings.