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147 Adherence was low as only 38.1% of respondents were in the high adherence level. Based on the review of patients‘ records, 48.9% may not have missed their medication, because they kept clinic appointments regularly. About 35% of respondents expressly reported ever missing their medicines schedules. Also, a higher proportion of respondents (51.4%) missed the exact timing but not an entire day of not taking drugs.
Various factors were examined to see how they modify adherence behaviour among patients.
The variables and key findings are: Male respondents adhered more to treatment-taking than female while the likelihood of defaulting from treatment was more likely among the unemployed and farmers. In addition, higher income earners were more associated with lower adherence than lower income earners. While low income earners were more concerned with lack of money, high income earners were more worried about stigmatisation. Place of residence (rural versus urban) was not important in explaining adherence level.
Counter-intuitively, good knowledge of treatment and implication of non-adherence was associated with lower level of adherence to treatment at bivariate levels of analysis while poor knowledge was associated with higher adherence. At the multivariate level, knowledge of treatment was not a significant predictor of adherence. The lesser the length of time spent on HIV treatment the better chances of attaining higher adherence levels. Also, the time frame of about six months, and below spent on tuberculosis treatment was more likely to engender higher levels of adherence.
Receipt of family support significantly influenced adherence behaviour among TB-infected HIV patients. Satisfaction was received family support was a predictor of higher levels of adherence. Respondents who do not live in the same community as the location of their treatment facility were more likely to achieve higher levels of adherence than those living near treatment facility, and those who pay high transportation to the clinics.
Furthermore, higher perception of self-efficacy was associated with higher levels of adherence. Patients who were very anxious about their health were likely to attain good adherence, while low self-stigma was significantly associated with higher levels of adherence. Low level of social stigma was generally reported among patients with much of it experienced by women, patients who were 20 years old or less, and those who lived in the same household with family members. However, social stigma was not a significant predictor of adherence. Situational factors such as ‗not being at home‘, ‗had not eaten‘ and ‗being busy with other things‘ were important reasons why patients missed taking their medicines.
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5.2 Conclusion
Based on the results and findings of this study, the following conclusions were drawn:
The level of patients‘ adherence to treatment regimen is below recommended levels and there is a serious need to scale-up adherence. This will lead to an improvement in treatment-taking behaviour, and subsequent improvement in the health and well-being of infected persons.
Measurement of adherence is complex, and may create an over- or underestimation of the level of patients‘ observance of recommended treatment. Factors on the individual level including socio-economic status, motivation, perceptions and knowledge are important in understanding, and explaining adherence to treatment of long-term illness.
Structural level factors including location of treatment facility, relationship between care-providers and patients, disruption in the provision of services and cost of reaching treatment facility are also as important as the individual level factor is explaining adherence to HIV and TB treatment.
5.3 Recommendations
Improving the up-take and increased adherence require multifaceted efforts. These efforts must address issues relating to both the patients themselves and the structure and social dynamics of treatment provision and taking. Consequently, the following recommendations are made:
1. Improving access to income-generating activities, especially for women can improve financial well-being and the ability to access health care (HIV and TB treatment) and quality nutrient intake to boost the nutritional status as drugs cannot be taken on empty stomachs.
2. Sustained patient counselling focusing on improving self-perception and the reduction of self-stigma can improve adherence. This will counter the shame and guilt feeling that infected persons usually have (that they caused their own problems), and because the conditions are stigma-related, counselling can improve the perception of self-worth, leading to higher levels of adherence.
3. Assignment of patients to treatment centres that are acceptable to them, and also within a reasonable distance to shield them from neighbours who will identify them as
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4. It is important to intensify continuing counselling of patients to improve their understanding of the treatment and the adverse implication of not adhering strictly to medications. This will counter the overly fatalistic faith and belief that healing comes from God and not from regular drugs taking.
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