Acceptability of modified directly observed therapy for Antiretroviral Therapy (ART) and associated factors among HIV patients in Arua Hospital

Abstract

Introduction: Combination ART has led to dramatic reductions in morbidity and mortality among patients with HIV/AIDS in Uganda. Successful treatment with ART requires the patient to maintain consistent adherence to the prescribed regimen on a long term basis. However, only 68% of the Ugandan urban patients interviewed reported an adherence rate of 95% to HAART. Modified directly observed therapy for ART has been suggested as an intervention for non-adherence. This study has shed light on acceptability of modified DOT and associated factors before its adoption. Objective: To assess acceptability of modified DOT-ART and associated factors among HIV-infected patients attending Arua hospital HIV clinic in 2010 Methods: Cross–sectional design using both qualitative and quantitative methods was conducted between February and March, 2010 among HIV-infected patients attending Arua hospital. Data were collected on acceptability of a modified DOT-ART, preference of different forms of modified DOT-ART, and associated factors. The proportion of patients who were willing to accept modified DOT-ART and proportion of patients who preferred different forms modified DOT-ART were determined. Using bivariate and multivariate analysis, factors associated with acceptability of modified DOT-ART were assessed. Statistical significance was determined using 95% confidence Interval and p-value (<0.05) of Odds Ratios as the measure of effect. Qualitative data was analyzed into themes. Results: A total of 358 participants were enrolled. Of these, 55.9% (200/358) were willing to accept modified DOT. The proportion of patients on ART who accepted modified DOT was 61.5% (110/179) and those not on ART was 50.3% (90/179). The majority, (58.5%, 117/200) of participants preferred home/family-based DOT among different forms of modified DOT-ART. Male patients (OR= 0.463, 95%CI= 0.68-0.799, P= 0.006), married patients (OR= 0.354, 95%CI= 0.129-0.973, P= 0.044), patients with low social support (OR= 0.616, 95%CI= 0.384-0.990, P= 0.045), and patients not receiving co-trimoxazole prophylaxis (OR=0.324, 95%CI= 0.151-0.696, P=0.004), were less likely to accept modified DOT for ART. While patients on ART (OR= 2.431, 95%CI= 1.357-4.353, P=0.003) and those who never ever missed ARV dose (OR= 2.192, 95%CI= 1.134-4.234, P=0.020) were more likely to accept modified DOT-ART. Conclusion: The study showed that over half of the participants were willing to accept modified DOT- ART. Home/Family-based approach was the most preferred form of modified DOT-ART. Acceptability of modified DOT was higher among patients on ART compared to those not on ART. Non-acceptance of modified DOT-ART was more common particularly among the males, the married; patients with low social support, non-adherent patients and patients not taking co-trimoxazole prophylaxis. Recommendations: There is need to further explore into the acceptability and feasibility of modified DOT to other populations before MOH can consider the use of mDOT as a strategy to strengthen adherence to ART particularly to highly non-adherent patients. As MOH considers use of mDOT, education of patients on what mDOT-ART entails will be key to the success of this program.