CHALLENGES IN HAART COMPLIANCE: FACTORS CONTRIBUTING TO POOR ADHERENCE IN HIV PATIENTS
DOI:
https://doi.org/10.71000/mdtcra20Keywords:
HIV, adherence, compliance, tuberculosis, Pakistan, Antiretroviral Therapy, StigmaAbstract
Background: Highly Active Antiretroviral Therapy (HAART) has significantly reduced HIV-related morbidity and mortality by suppressing viral replication and improving immune recovery. However, maintaining adherence above 95% remains challenging, particularly in low- and middle-income countries where social stigma, limited literacy, and comorbid conditions persist. Poor adherence not only diminishes treatment efficacy but also promotes drug resistance and continued transmission of infection, underscoring the importance of identifying context-specific determinants of non-compliance among HIV patients.
Objective: To identify the factors associated with poor adherence to HAART among individuals living with HIV in a tertiary care setting in Lahore, Pakistan.
Methods: A descriptive cross-sectional study was carried out at the HIV clinic of a tertiary hospital in Lahore between January and June 2024. A total of 210 HIV-positive patients aged 18 years or older, who had been on HAART for at least six months, were enrolled using consecutive sampling. Adherence was evaluated through a structured questionnaire and verified by pharmacy refill data. Missing more than 5% of prescribed doses in the previous 30 days was considered poor adherence. Data were analyzed using SPSS version 25. Descriptive statistics were calculated, while chi-square and logistic regression tests identified associations and independent predictors of non-adherence, with p < 0.05 considered significant.
Results: The study included 142 males (67.6%) and 68 females (32.4%) with a mean age of 37.4 ± 9.2 years. Overall, 84 participants (40%) were non-adherent to HAART. Major reasons for non-adherence included forgetfulness (38.1%), stigma or fear of disclosure (25%), drug side effects (20.2%), financial constraints (10.7%), and tuberculosis co-infection (6%). Logistic regression revealed significant associations between poor adherence and low educational status (p=0.01), stigma (p=0.02), and TB co-infection (p=0.04).
Conclusion: Poor adherence to HAART remains a major barrier to optimal HIV care in Pakistan. Stigma, limited literacy, and co-existing tuberculosis emerged as key predictors. Interventions enhancing patient education, psychosocial counseling, and integration of TB/HIV services are vital for improving adherence and long-term treatment outcomes.
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