From Access to Adherence: The Challenges of Antiretroviral Treatment - Studies from Botswana, Tanzania and Uganda, 2006: Factors that facilitate or constrain adherence to antiretroviral therapy among adults in Uganda: a pre-intervention study: Chapter 6: Results: 6.1 Demographic characteristics of ARV users

From Access to Adherence: The Challenges of Antiretroviral Treatment - Studies from Botswana, Tanzania and Uganda, 2006
(2006; 320 pages)

Índice de contenido

Acknowledgments
Acronyms and abbreviations
Foreword
1. On hunger, transport costs and waiting time: a synthesis of challenges to ARV adherence in three African countries
	Introduction
	Methods
	Discussion
	Conclusion
	References
2. Overview of antiretroviral therapy, adherence and drug-resistance
	Background
	References
3. From training to action: the process of engaging health professionals in operational research on adherence to antiretroviral therapy
	Introduction
	Promoting the rational use of drugs
	Promoting Rational Drug Use in the Community course
	Three ARV adherence studies: the process
	How the process was funded
	Discussion and conclusion
	References
	Annex 1: PRDUC course participants by region, type of institution, sex and source of funding
	Annex 2: URLs for country proposals
	Annex 3: Call for proposals
4. There's hope - early observations of ARV treatment roll-out in South Africa
Factors that facilitate or constrain adherence to antiretroviral therapy among adults at four public health facilities in Botswana: a pre-intervention study
	Acknowledgements
	Acronyms and abbreviations
	Executive summary
	Chapter 1: Introduction
		1.1 Research problem
		1.2 Research questions
		1.3 Study objectives
	Chapter 2: Background
		2.1 History of HIV and AIDS in Botswana
		2.2 Botswana's ART programme
		2.3 Literature review
		2.4 Definition of concepts
	Chapter 3: Methodology
		3.1 Introduction
		3.2 Study design
		3.3 Study population
		3.4 Description of study sites
		3.5 Inclusion and exclusion criteria
		3.6 Selection and training of data collectors
		3.7 Qualitative data collection
		3.8 Observations
		3.9 Semi-structured interviews
		3.10 Exit interviews
		3.11 Focus group discussions
		3.12 Quantitative data
		3.13 Data analysis
		3.14 Emic perspective
		3.15 Ethical considerations
		3.16 Feedback
	Chapter 4: Quantitative results
		4.1 Adherence measurement tool results
		4.2 Rates of adherence to ARVs
		4.3 Reasons for skipping medication
		4.4 Factors affecting adherence to ART
		4.5 Predictors of adherence to ART
		4.6 Quantitative results of exit interviews
	Chapter 5: Qualitative results
		5.1 Constraints to adherence to ART
		5.2 Facilitators of adherence to ART
		5.3 Observation of health facilities 5.3.1 Structural issues
		5.4 National level policy issues
	Chapter 6: Discussion, conclusion and recommendations
		6.1 Discussion
		6.2 Conclusions
		6.3 Recommendations
	References
	Annex 1: Mean of rates adherence
	Annex 2: Multivariate logistic regression analyses on the predictor variables
	Annex 3: Questionnaires
A study on antiretroviral adherence in Tanzania: a pre-intervention perspective, 2005
	Acknowledgements
	Acronyms and abbreviations
	Executive summary
	Chapter 1: Introduction
		1.1 Background
		1.2 Rationale
		1.3 Literature review
		1.4 Problem statement
		1.5 Objectives
		1.6 Output
	Chapter 2: Methodology
		2.1 Study design
		2.2 Study population
		2.3 Inclusion and exclusion criteria for interviewees
		2.4 Quantitative data
		2.5 Qualitative data
		2.6 Data collection tools
		2.7 Pilot study
		2.8 Sample size and sampling strategy
		2.9 Data collection
		2.10 Ethics
	Chapter 3: Study areas
		3.1 Health care facilities
	Chapter 4: Quantitative results
		4.1 Demographic characteristics of ARV users
		4.2 Adherence rates
	Chapter 5: Qualitative results
		5.1 Factors that influence adherence to ARVs from the users' perspective
		5.2 Quality of operating structures
		5.3 Opinions and suggestions given by respondents to improve provision of ARVs
	Chapter 6: Discussion, conclusion and recommendations
		6.1 Discussion
		6.2 Conclusion
		6.3 Recommendations
		6.4 Proposed interventions
	References
	Annex 1: Exit interview with ARV users
	Annex 2: Semi-structured interview with ARV users
	Annex 3: ARV users, FGDs
	Annex 4: Adherence measurement tools
	Annex 5: Key informant interview
	Annex 6: Semi-structured interviews (with staff)
	Annex 7: Observation (consultations)
	Annex 8: Observation of antiretroviral
Factors that facilitate or constrain adherence to antiretroviral therapy among adults in Uganda: a pre-intervention study
	Acknowledgements
	Glossary
	Executive summary
	Chapter 1: Introduction
		1.1 Background
		1.2 Research problem
		1.3 Research objective
	Chapter 2: Background to the study
		2.1 History of AIDS in Uganda
		2.2 History of ARVs in Uganda
	Chapter 3: Literature review
		3.1 Importance of adherence to ART
		3.2 Measurement of adherence
		3.3 Factors affecting adherence to ART
		3.4 Impact of the drug regimen on adherence
		3.5 Treatment characteristics affecting adherence 3.5.1 Physical state and disease stage
		3.6 The clinic setting and service provision
		3.7 Simplifying treatment regimes to improve adherence
		3.8 Conceptual framework
	Chapter 4: Methodology
		4.1 Study design
		4.2 Study population
		4.3 Inclusion and exclusion criteria
		4.4 Sample size and selection
		4.5 Data collector selection and training
		4.6 Pilot testing
		4.7 Data collection
		4.8 Data analysis
		4.9 Evaluation of methods
		4.10 Ethical considerations
	Chapter 5: Description of the study sites
		5.1 Jinja Regional Referral Hospital
		5.2 Nile Treatment Centre
		5.3 Study limitations
	Chapter 6: Results
		6.1 Demographic characteristics of ARV users
		6.2 Factors influencing adherence to ART
	Chapter 7: Discussion, conclusions and recommendations
		7.1 Discussion
		7.2 Conclusions
		7.3 Recommendations
	References
Back cover

6.1 Demographic characteristics of ARV users

The study was conducted at Jinja Regional Referral Hospital (JRRH) and Nile Treatment Centre (NTC) both in Busoga region. A total of 200 respondents (109 from JRRH and 91 from NTC) participated in the study. Demographics were calculated for all the ARV users who participated in the study from adherence, exit and semi-structured interviews. Twenty six (37%) of the ARV users were male and 44 (63%) were female. Fifty-six per cent of the participants had been on ART for two years or less and the rest (44%) had been on ARVs for more than two years (Table 2).

Table 2: Length of time participants have been taking ARVs, by site

Duration taking ARVs (months)	JRRH		NTC		Total
	Number	Percent	Number	Percent	Number	Percent
< 3 months		0	4	11	4	6
3 - 6	4	11	14	39	18	25
7 - 12	13	37	5	14	18	25
13 - 18	3	9	3	8	6	8
19 - 24	3	9	0	0	3	4
25 - 30	2	6	2	6	4	6
31 - 36	2	6	2	6	4	6
37 - 42	0	0	2	6	2	3
43 +	8	23	4	11	12	17
Total	35	100	36	100	71	100

Of the 71 respondents interviewed, 40 (56%) had finished secondary education, 17 (24%) had completed primary education and 14 (20%) had completed tertiary education. The lowest educational level was seven years' schooling (Table 3).

Table 3: Educational status of study participants

Education Level	Number who completed	Percentage (%)
Primary	17	24
Secondary	40	56
Tertiary	14	20
Total	71	100

While ARVs were provided free of charge at the public facility (JRRH), most patients (97%) at the private facility (NTC) reported a monthly expenditure of Ushs 5000 (US$ 3.00) in the form of user fees. Overall, 82% (58) of the patients at the two facilities incurred additional costs associated with obtaining or taking ARVs. Only 18 % (13) did not incur such additional costs (Table 4). There were no significant differences in the additional costs between the two facilities.

Table 4: Costs incurred by ARV users per month

ARV costs in Uganda shillings*	JRRH N = 35	NTC N = 36	Total N = 71
	Percent	Percent	Percent
<5000	97	0	48
>5000 <10000	3	97	51
10000+	0	3	1
Total	100	100	100
Other Costs
No	17	19	18
yes	83	81	82
Total	100	100	100

* US$ 1.00 = approx. 1700 Uganda shillings (Ushs)

The average distance travelled to the health facility was 20 km, with the minimum distance being 1 km and the maximum distance travelled 184 km. Distances were considered because they had implications for costs, which in the long run may affect adherence (Table 5).

Table 5: Distance travelled to the health facility by ARV users on each visit

Distance (km)	JRRH		NTC		Total
	Number	Percent	Number	Percent	Number	Percent
1 - 10	24	69	18	50	42	59
11 - 20	3	9	3	8	6	8
21 - 30	2	6	4	11	6	8
31 - 40	4	11	2	6	6	8
41 - 50	1	3	3	8	4	6
51 +	1	3	6	17	7	10
Total	35	100	36	100	71	100

A considerable number of patients on treatment had to travel at least 10 km to the clinic which may also be a significant factor in relation to adherence. This implies that some of them had to travel by taxi or hire a bicycle, entailing extra cost for the client, while those who came from far away had no alternative but to shoulder the additional transport costs.