Factors influencing adherence to antiretroviral therapy among patients with high human immunodeficiency virus viral loads attending Serem Comprehensive Care Centre, Vihiga County, Kenya

Nahashon Ouko; Nathan Kiboi; Nathan Shaviya; Tom Were

doi:10.51867/ajernet.7.4.68

Authors

Nahashon Ouko Masinde Muliro University of Science & Technology, Kenya https://orcid.org/0000-0002-7783-0550
Nathan Kiboi South Eastern Kenya University https://orcid.org/0000-0002-2417-6399
Shaviya Nathan Masinde Muliro University of Science and Technology (MMUST) https://orcid.org/0000-0001-7347-3130
Tom Were Masinde Muliro University of Science and Technology, Kenya https://orcid.org/0000-0002-0349-9906

DOI:

https://doi.org/10.51867/ajernet.7.4.68

Keywords:

Adherence, Antiretroviral Therapy, High Viral load, HIV, Opportunistic Infections

Abstract

Virological non-suppression remains a challenge in Human Immunodeficiency virus-HIV care, particularly where treatment monitoring and adherence support are constrained. This heightens the risk of disease progression, transmission dynamics and drug resistance. This study assessed factors associated with self-reported antiretroviral therapy (ART) adherence among patients with a documented HIV-1 RNA level of at least 1,000 copies/mL at Serem Comprehensive Care Centre, Vihiga County, Kenya. This was a facility-based cross-sectional study. HIV-1 RNA was measured in plasma, CD4+ T-cell counts in EDTA-anticoagulated blood, cryptococcal antigen in serum, and tuberculosis screening was performed using GeneXpert MTB/RIF according to SOP. Adherence was assessed with the eight-item Morisky Medication Adherence Scale (MMAS-8). Descriptive statistics and exact or chi-square tests were used for categorical variables. Of 590 patients active in care, 94 (15.9%) had an HIV-1 RNA level ≥1,000 copies/mL. The ART duration <5 years was significantly linked with poor adherence (p= 0.031). Associations with viral load, CD4+ T-cell count, age, and marital status did not meet the prespecified α = .05 threshold (p = .067, .072, .078, and .064, respectively). The findings support intensified, non-judgmental adherence assessment and enhanced adherence counseling for patients with unsuppressed viral load. They did not establish that poor adherence caused virological non-suppression, and the results should not be generalized beyond this facility-based sample without further study. Study findings necessitate enhanced ART adherence counseling, routine screening for opportunistic infections and integrated care model that is well-tailored to suit comprehensive care needs.

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