DETERMINANTS OF MEDICATION ADHERENCE AMONG PATIENTS ON CONCOMITANT TUBERCULOSIS AND ANTIRETROVIRAL THERAPY IN KOGI STATE NIGERIA

Abstract

Non-adherence to antiretroviral (ARV) medications as well as drugs used to treat tuberculosis (TB) can lead to manifestations of drug-resistant strains of mycobacterium tuberculosis. This study aimed at assessing the level of medication adherence and its determinants among patients living with HIV/AIDS and TB co-morbidity. A well structured questionnaire for the study of ART and anti TB medication adherence and its determinants was designed and the validity of the questionnaires was assessed through in-depth discussion with experienced consultants working in the ARD/TB clinic of the Federal Medical Center, Lokoja. The questionnaire was pre tested on eight patients on TB and ART concomitant treatment attending Kogi State Specialist Hospital, Lokoja and necessary corrections were made accordingly. The questionnaire used was divided into four parts: The first part was used to record the overall patient’s socio- demographic characteristics and clinical information. The second part was the Medication adherence tool containing questions like frequency of times the patient missed a dose per month, reason of missing doses, how to compensate for the missed doses, what they did when their medications finished before refilling. The third part was the patient and health provider (physician, pharmacist, nurse) relationship questionnaire. The final part was used to asses health literacy of the patients which included questions such as whether the patient know missing doses of ARV and anti-TB will result in treatment failure or development of drug resistant, possible ways of transmission of HIV/TB and measure taken to prevent possible transmission of TB to the family members. The questionnaires were checked by the research pharmacists at the end of each day during the survey, for omission of incomplete answers and for coding the responses. Primary outcome measure was medication adherence, while secondary outcome measures were health literacy of patients and patient relation with their healthcare providers. Data was extracted from completed questionnaires, coded and entered into the Microsoft excel sheet for statistical analysis using SPSS 16.0. A total of 450 patients that participated in the study were on antiretroviral and only 60 (13.3%) of them were co-infected with both HIV and tuberculosis and are on both ARV and TB medications. Majority of the respondents were male (63.3%) and are above 45 years of age. About 23 of the patients were said to be single, 20 patients were married, and 8 of them were divorced/separated while 17 of them were widowed. About 81.7% of the respondents have one form of education or the other. Less than half of the respondents have a source of income. 23 persons (38.3%) reported never to have missed their ARV’s while only 18 persons (30%) reported never to have missed their tuberculosis medications. About 8 patients (13.3%) for ARV’s and 10 patients (16.7%) for anti-TB reported ‘forgetfulness’ as the reason for missing their medications. Majority of the patients (31.7% for ARV’s and 18.3% for anti-TB) reported that experiencing side effects was the reason for missing their medications. Also most of the patients (11.7% for ARV’s and 20.0% for anti TB) said the reason they missed their medications was because they did not have money to transport themselves to the health facility. For the ARV’s, only 8 persons (13.3%) said the reason they missed their medications was because they were getting bored of the whole treatment or feeling worse about their condition. Only 5 persons (8.3%) for ARV’s and 3 persons (5.0%) said the reason they missed their medications was because they were already feeling better. 90% of the respondents reported good relationship with Physician. Medication adherence is of paramount importance to achieve optimal economic, clinical and humanistic outcome. From the study, majority of the patients (78.3%) have the knowledge about the fact that missing doses of ARV and anti TB results in treatment failure. Forgetfulness, side effect and lack of money for transportation were the major reasons reported by the patients as to why they missed their medications, while gender, age, educational status and employment status do not play a significant role in the adherence of both the ARV’s and anti-TB therapy.