ASSESSMENT OF FACTORS AFFECTING ADHERENCE TO

ANTIRETROVIRAL THERAPY IN ANBESSAMIE HEALTH CENTER,

AMHARA, ETHIOPIA.

BY: - HULUBANCH ATALEL, LIBSEWORK BELAY, TSIGEREDA SISAY,

ABAY WORKU

A THESIS SUBMITTED TO RIFT VALLEY University, DEPARTMENT OF

PHARMACY, IN PARTIALFULFILLMENT OF THE REQUIREMENT FOR
BACHELOR DEGREE IN PHARMACY (B.PHARM).

FEB, 2022

BAHIR DAR, ETHIOPIA

I|Page
 RIFT VALLEY UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES DEPARTMENT

OF PHARMACY

TITLE:-ASSESMENT OF FACTORS AFFECTING ADHERANCE TO

ANTIRETROVIRALTHERAPY IN ANBESSAMIE HEALTH CENTER
ART CLINIC, AMHARA, ETHIOPA.
BY: - HULUBANCH ATALEL, LIBSEWORK BELAY, TSIGEREDA SISAY,
ABAY WORKU

ADVISOR: - ASRAT AYALEW (BSC, MPH)

FEB, 2022

BAHIR DAR, ETHIOPIA

II | P a g e
ABSTRACT
Background: Antiretroviral therapy is a life saver for individual patients treated for Human
Immunodeficiency Virus and Acquired Immune Deficiency Syndrome. Maintaining optimal adherence to
antiretroviral drugs is essential for Human immunodeficiency virus infection management. Patient
adherence is a dynamic phenomenon broadly affected by patient, medications, disease, provider and systems
factors.

Objectives: To assess factors that affect adherence to antiretroviral therapy among people living with
Human immunodeficiency virus/Acquired immune deficiency syndrome who are on Highly Active
Antiretroviral Therapy in Anbessamie health center, Amhara, Ethiopia.

Methods: A cross sectional study was conducted to a PLWHA who are attending Anbessamie health
center, ART clinic in the study period of August 1 to September 30, 2021. Convenient sampling technique
was used, since the study attempted to cover all consecutive patients who attend ART pharmacy to refill
their ARV drugs over the study period. The inclusion criteria for this study were RVI patients aged greater
than 18 years in ART clinic of SRH during study period. The study was conducted from August 1 to
September 30, 2021. Descriptive analysis was done using SPSS version 16.0 analyzing software.

Results: Out of total study subjects 146 (48.67%) were male and 154(51.33%) were female; most of the
respondents (50%) were between 29-39 years old. One hundred and fifty nine (53%) of clients were
orthodox by religion followed by Muslim 27.33%. One hundred and sixteen (38.6%) subjects had secondary
education. Most of the respondents, 210 (70%) were married .Most of respondents 150 (50%) are 4-7years
duration on HAART while 10(3.33%) are below one years. Majority of the respondents 284(94.67%) had no
HIV related hospitalization and 16(5.3%) had HIV related hospitalization and all of them got treatment.
Most of the respondents 244(81.34%) didn’t use social drug and 56(18.67%) use social drug, among these
28(50%) and 12(31.33%) use alcohol and chat respectively.

Conclusion and Recommendation: Adherence rate in the present study were relatively moderate to high.
There are a range of reasons for failing to adhere to ART including, having drug side-effects, non-disclosure
of HIV status and use of social drug. The main reasons for missing of the doses were forgetting, being too
busy, being away from home and being ill.

Key words: Adherence, Antiretroviral therapy, HAART, ART Clinic, Anbessamie health center.

III | P a g e
ACKNOWLEDGEMENTS
First of all I would like to express my deepest gratitude to our research advisor Mr.Asrat (BSC, MPH) for
his indispensable comment and suggestions in conducting this research paper.

I would like to extend my special thanks to Rift valley University College of medicine And Health Science
Department of pharmacy for giving ours this chance to conduct the study. My sincere appreciation goes to
my closely friends for their support on data collection and analyzing.

I would like to thank all who gave ours advice through the development of our research. Finally our deepest
gratitude goes to Anbessamie health center staff workers who helped and allowed ours in collecting and
gathering data from the hospital.

IV | P a g e
Table of Contents

Contents
ABSTRACT......................................................................................................................................................................... III
ACKNOWLEDGEMENTS......................................................................................................................................................... IV
Table of Contents................................................................................................................................................................... V
List of tables......................................................................................................................................................................... VII
List of figures...................................................................................................................................................................... VIII
Agronomies and Abbreviations............................................................................................................................................. IX
1 .Introduction....................................................................................................................................................................... 1
1.1 Background...................................................................................................................................................................... 1
1.2 Statements of the problems............................................................................................................................................. 4
1.3. Significance of the Study................................................................................................................................................. 5
2. Literature Review............................................................................................................................................................... 6
3. OBJECTIVE.......................................................................................................................................................................... 8
3.1 General objective:......................................................................................................................................................... 8
3.2 Specific objectives:......................................................................................................................................................... 8
4. METHODS AND MATERIALS................................................................................................................................................ 9
4.1 Study area and period...................................................................................................................................................... 9
4.2 Study Design.................................................................................................................................................................... 9
4.3 Population........................................................................................................................................................................ 9
4.3.1 Source population......................................................................................................................................................... 9
4.3.2 Study population........................................................................................................................................................... 9
4.4 Eligibility criteria............................................................................................................................................................... 9
4.4.1 Inclusion criteria............................................................................................................................................................ 9
4.4.2 Exclusion criteria........................................................................................................................................................... 9
4.5 Study Variables.............................................................................................................................................................. 9
4.5.1 Dependent Variables..................................................................................................................................................... 9
4.5.2 Independent Variables.............................................................................................................................................. 10
4.6 Sample Size Determination........................................................................................................................................... 10
4. 7 sampling procedure....................................................................................................................................................... 10
4.8 Data collection instruments.......................................................................................................................................... 10
4.9 Operational Definition.................................................................................................................................................... 10

V|Page
4.10 Data processing and Analysis....................................................................................................................................... 11
4.11 Data Quality Assurance................................................................................................................................................ 11
4.12 Ethical Consideration................................................................................................................................................... 11
4.13 Dissemination of the results.................................................................................................................................... 11
5. RESULTS............................................................................................................................................................................ 12
5.1 Socio-demographic characteristics of the respondents.................................................................................................. 12
5.2 Duration of respondents on HAART............................................................................................................................... 13
5.3 Disclosure status of the respondents............................................................................................................................. 14
5.4 psychiatric illness status of the respondents.................................................................................................................. 15
5.5 Reason of respondent for missing the dose................................................................................................................... 15
5.6 How patients compensated unscheduled drugs............................................................................................................. 16
5.7 Patient physician relationship........................................................................................................................................ 17
5.8 Social drug use of the respondents................................................................................................................................ 18
5.9 Association of different socio-demographic Variable with adherence rate....................................................................18
5.10 Association of side effects, reason for missing and duration on HAART in august 1 to September 30, 2021, Amhara,
Ethiopia................................................................................................................................................................................ 19
6. DISCUSSION...................................................................................................................................................................... 21
7. LIMITATIONS OF THE STUDY............................................................................................................................................ 22
8. CONCLUSIONS AND RECOMMENDATIONS....................................................................................................................... 23
7.1CONCLUSIONS................................................................................................................................................................. 23
7.2 RECOMMENDATIONS..................................................................................................................................................... 23
Reference............................................................................................................................................................................. 24
Verbal Consent Form........................................................................................................................................................... 26

VI | P a g e
List of tables
Table 1 Socio-demographic characteristics of the respondents at Anbessamie health center ART clinic from
august 1 to September 30, 2021, Anbessamie, Amhara, Ethiopia...................................................................12
Table 2 Duration of respondents on HAART in Anbessamie health centre ART clinic from august 1 to
September 30, 2021, Amhara, Ethiopia...........................................................................................................13
Table 3 Side effects faced by respondents at SRH ART clinic from august 1 to September 30, 2021,
Amhara, Ethiopia.............................................................................................................................................14
Table 4 Disclosure status of the respondents at SRH ART clinic from august 1 to September 30, 2021,
Amhara, Ethiopia.............................................................................................................................................14
Table 5 how patients compensated unchanged drugs august 1 to September 30, 2021, Amhara, Ethiopia.16
Table 6 Patient physician relationship in august 1 to September 30, 2021, Amhara, Ethiopia.......................17
Table 7 Association of different socio-demographic Variable with adherence rate in august 1 to September
30, 2021, Amhara, Ethiopia.............................................................................................................................18
Table 8 Association of side effects, reason for missing and duration on HAART in august 1 to September
30, 2021, Amhara, Ethiopia.............................................................................................................................20

VII | P a g e
List of figures
Figure 1 Psychiatric illness status of the respondents in Anbessamie health center ART clinic from august 1
to September 30, 2021, Amhara, Ethiopia.......................................................................................................15
Figure 2 Reason of respondents for missing the dose in SRH ART clinic from March.................................16
Figure 3 Social drug use of the respondents in august 1 to September 30, 2021, Amhara, Ethiopia.............18

VIII | P a g e
Acronym and Abbreviations
ART: Antiretroviral therapy
ARV: Anti retrovirus
CBE: Community Based Educations
HAART: Highly Active Antiretroviral Therapy
HIV/AIDS: Human immunodeficiency virus/acquired immunodeficiency syndrome
NGO: Non-governmental Organization
NNRTI: Non-nucleoside reverses transcriptase inhibitor
PEPFAR: President's Emergency Plan for AIDS Relief
PLWH: people living with Human immunodeficiency virus
PI: Protease inhibitor
UNAIDS: United Nations programmers on HIV and AIDS
WHO: World Health Organization

IX | P a g e
1 .Introduction

1.1 Background
The Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) is
one of the most destructive epidemics and a major threat to world population, affecting
overall social, economic and political wellbeing as well as individual health. There were an
estimated 34 million people living with HIV/AIDS (PLWHA) in 2011. The majority, 97%, of
them were from low and middle-income countries .Sub-Saharan Africa is the most affected
region contributing more than 69% of the total.(8)

Medical knowledge around HIV/AIDS has increased significantly over the years and good
progress has been made in the treatment of HIV as a manageable life-threatening chronic
condition using antiretroviral therapy (ART). The treatment of the disease extends beyond
knowledge development among people infected with HIV; a partnership between them and
healthcare providers is required, with the HIV-infected person assuming the major
responsibility of self-care that will result in adherence and a good clinical outcome. This is
the reason why medication adherence is described as the extent to which the individual’s
behaviour corresponds to the prescribed medical advice of the health care provider.(3)

The outcome of antiretroviral treatment (ART) has dramatically slowed down the progression
of HIV, reduced the death rate from AIDS and transformed the infection from a fatal illness
to a more manageable chronic illness. However, simply making ART medicine available to
PLWHA is not enough, as strict adherence is required for treatment success (7).

Medication adherence is a major challenge in chronic medical condition. Adherence levels

changeover time. Clinical experience and research indicate that adherence is a “moving
target”; the longer a patient stays on treatment the poorer the adherence is likely to become.
Adherence are higher among patients who are taking medications for acute medical
conditions compared to those with chronic medical conditions. In addition to this, adherence
levels among patients with chronic diseases, no matter how impressive adherence is initially,
have been reported to drop dramatically after six months. HIV-infected persons have been
shown to adhere better than the general population; the average adherence to chronic
medications among the general population is 50% which is far below the self-report
adherence rate of between 55–77% among patients on ART. According to the 2011 Ministry
of Health report, about 333,453 PLWHA were on antiretroviral treatment (ART) in Ethiopia
(51).

1|Page
Antiretroviral therapy (ART) is offered at public/ government, private and faith-based
hospitals and health centres throughout the World. It is provided free of charge, with the
Ministry of Health in control of the treatment programs. As of 2013, there were 689 health
facilities offering antiretroviral therapy to patients .At the time of study in 2013, the World
Health Organization(WHO) recommended that an individual starts ART treatment once
his/her CD4 count was ≤350 cells/mm . Malawi implemented the 2013 WHO’s guidelines on
HIV treatment by adopting the more accepted CD4 count threshold for initiating ART (350
cells/cu.mm) and switching first‐line ART from stavudine (d4T) to tenofovir (TDF)
containing regimens. The government has tried to meet WHO’s recommendations by getting
more patients into treatment (4).

In addition to its life-prolonging effects, ART can also reduce HIV transmission to uninfected
people. According to Regensburg (2013) there has an initiative in South Africa of a fixed
dose combination of two or more active drug in a single pill. Instead of people living with
HIV/AIDS (PLWHA) taking two or three different pills, they can take one pill a day which
includes several ARVs. The fixed combination contain TDF, FTC, or 3TC and EFV first line
regimen, which has been made available in private sectors and developed public sectors
starting from2013(6).

The HIV and AIDS epidemic, experiencing 48% of the world’s new HIV infections among
adults, 55% among children, and 48% of AIDS-related deaths (UNAIDS 2013). Out of this
crisis, countries in the region have emerged as some of the world’s leading nations in HIV
testing, up-scaling ART coverage, and increasing condom usage. The past five years or so
have seen the rise of the ‘HIV treatment as prevention’1 approach, whereby treatment
reduces viral load to the point where an infected person is much less infectious to others.
Treatment as prevention is a core component of the post-2015 UNAIDS global Fast-Track
strategy to end AIDS as a public health concern by 2030. (11)

Many barriers to adherence are common to both developed and developing countries such as
fear of disclosure. However, some are more common in the Asian developing countries such
as ART-associated costs (transport cost, diagnostic costs) and problems with travel to access
treatment. Hence, to benefit from ART, it is important to identify adherence behaviour,
understand the conditions that lead to non-adherence and develop strategies and social
policies to maximize long-term adherence. Four categories of issues (regimen characteristics,
various patient factors, the relationship between provider and patient at the system of care)
have usually been found to foresee hitches with adherence to medication.(12, 13).

2|Page
A key factor to the successful treatment of HIV is good adherence to ART, which is critical
to obtain its full benefits: maximal and durable suppression of viral replication, reduced
destruction of cluster differentiation T-lymphocyte (CD4) cells, prevention of viral resistance,
promotion of immune reconstitution and slowed disease progression. Several studies have
indicated that adherence greater than 95% is required for ART to achieve clinical,
immunologic and virology success (14).

The lack of adherence to treatment is an interaction between the patient, the regimen, the
providers of therapy, and the environment in which this occurs. The interaction was the
context in which adherence does or does not occur. The issue of adherence requires expertise,
collaboration, and coordination of services within primary care, specialist care, social service
settings and the broad multidisciplinary team (15).

Self-reporting and tablet counting methods were used to determine HAART treatment
medication adherence at the end of each month consecutively for eighteen months. In tablet
counting, patient’s medical records were reconciled against the medicines yet to be used by
the patients which were brought to the pharmacy as a routine for refill of prescriptions by
patients.(50)

3|Page
1.2 Statements of the problems
The sustainable effectiveness of ART depends on patient's ability to adhere with their long-
term ART .Poor adherence to treatment of chronic disease is a world problem and also results
in waste and underutilization of already existed resource. Unlike treatments used in many
other chronic disease treatment of HIV/AIDS requires extremely high level of adherence,
which requires a level of 95%. But in practice many studies shows that there is poor
adherence; for instance literature review of 30 studies from North America and 22 from
Africa(15fromsubSaharan) the adherence level averagely is 54.7% and 77.1%,respectively
which is below level of adherence(21).

The advent of antiretroviral treatment (ART) has dramatically slowed down the progression
of HIV, reduced the death rate from AIDS and transformed the infection from a fatal illness
to a more manageable chronic illness. However, simply making ART medicine available to
PLWHA is not enough, as strict adherence is required for treatment success (9).

To achieve the full benefits of ART, strict adherence to the treatment instructions is very critical.
Sticking to the treatment instructions for a long-term illness is extremely challenging to the
patients (WHO, 2004). Medicine on its own might not solve HIV- and AIDS-related issues.
Worldwide and regardless of the illness or treatment, many people do not take their medication
correctly. While ART has improved the lives of many people worldwide, a lack of adherence to
HAART is still a major challenge to HIV and AIDS care resulting in serious public health
consequences (UNAIDS 2011). Failure to adhere to the taking of medication often leads to
treatment failure, development of viral mutations, and the emergence of drug resistance strains of
the virus (DOH, 2010).(19)

4|Page
1.3. Significance of the Study
The broader aspects of defaulter, reasons and associated factors were not identified. To reach
the 95%(or more) level of antiretroviral drug dosing adherence to maintain suppression of
viral replication, it is necessary to identify, describe, and deal with factors associated with
long-term defaulting from treatment. Therefore set out to determine rates of and factors
associated with non-adherence among ART users are important. In light of this, it is relevant
to investigate and document the prevalence and socio-economic, behavioural and other
factors linked to adherence to ART (17).

The study explored factors that influenced individuals to adhere to antiretroviral therapy and also
explored factors surrounding the individual that would be implemented to increase patients’
adherence levels. Maintaining high adherence levels would make patients enjoy fully the benefits
of ART when they realise improvement in their quality of life. There will also be reduction of
mortality and morbidity due to AIDS thereby lessening the number of orphaned children due to
HIV and AIDS. Furthermore, if high levels of adherence are maintained patients will continue on
first line therapy which is 6 much cheaper and the burden of switching over patients to second
line therapy as a result of drug resistance will be reduced.(31)

Political support and commitment has significantly increased in more recent years mainly
because of persistent pressure from the UN Theme Group and other members of the donor
community and increased awareness about the devastating effects of the AIDS epidemic in the
general population. As a result of these changes senior government officials have started using
political meeting to discuss AIDS and to be more actively involved in AIDS prevention efforts. In
December 2000; the Tanzania AIDS Commission (TACAIDS) was formed in the Prime
Minister’s Office to provide strategic leadership for and coordinate the implementation of a
national multi-sectoral response to HIV/AIDS (33)

5|Page
2. Literature Review
HIV/AIDS is the greatest health problem in the world. Multiple factors which are a barrier to
adherence to HIV/AIDS treatment, among there poverty is one which affects the adherence
to care, patients with no financial power struggle to travel to the clinics that provide ARV
treatment. Among patients who were no longer accessing ARVs, 25% had moved to other
catchment areas (e.g. Orange-Farms, informal settlements). Effects of poverty such as shelter,
hunger, violence from others, and lack of social support contribute immensely to non-
adherence to ARV treatment, and in South Africa there was high level of poverty and
unemployment in 2010, pitching 67% of people over the age of 18 and the majority being
blacks. As a result, patients ran out of ARV treatment due to the lack of money for food and
transport PLWHA take their ARVs without food, there may be severe complications such as
ulcers, haemorrhage (internal bleeding) and meningitis (6).

Measuring adherence is problematic as there is no single method to assess adherence accurately.

Studies use different techniques to assess adherence to HAART. The most commonly used
methods are; self-reports, pill counts, pharmacy records, biological markers, electronic devices
and measuring drug levels in the blood(44)

Stigmas have profound effects on the mental health of PLWH and those caring for the
mandthuscan negatively influence adherence to treatment in Western settings as well as in
sub-Saharan Africa and India. Patients reported that perceptions of stigma and fear of
discrimination prevented them both from purchasing and taking their medication. They were
less likely to disclose their status to colleagues, friends, and others. Non-disclosure may lead
to patients taking their ARV medicines secretly and irregularly because of inadequate social
support and encouragement (22).

A number of studies have shown that a more than 95% adherence rate is required if a patient
is to receive all the benefits of ART and minimize the possibility of treatment failure
established that the relationship between a >95% adherence rate and a final viral load of
<1000 copies/ml was closer than the relationship between a >90% adherence rate and a final
viral load of <1000 copies/ml (26).

Most ART adherence studies were conducted in high-income countries. Only a few studies
assessed adherence rates or predictors in low and middle-income countries. The findings of a
study which investigated adherence to ART and associated factors among PLWHA receiving
ART in six health centres in northwest Ethiopia, a low-income country in East Africa. The
region was identified to be among the most HIV affected parts of the country . The study will

6|Page
fill a critical gap in understanding ART adherence in Ethiopia and contributes to the growing
adherence research in low income countries. (51)

Successful multiple-drug combinations of ART began in the mid-1990s. Since that time
numerous swings in the expert opinion regarding the appropriate time begin. According to the
Panel on Antiretroviral Guidelines for Adults and Adolescents (2011), ART should be
initiated in all patients with a history of an AIDS-defining illness, with a CD4 count less than
350 cells/mm3, pregnancy, HIV- associated nephropathy, or hepatitis B virus (HBV) co-
infection. Despite this, current opinion is split on whether to start ART earlier than at CD4
counts<350 cells/mm3. According to the expert opinion of the Working Group of the Office
of AIDS Research Advisory Council Patients, a panel of the U.S. Department of Health and
Human Services (2011), there are four cited reasons that opinions have shifted to earlier
initiation of ART. (47)

7|Page
3. OBJECTIVE

3.1 General objective:

 To assess the extent of adherence to antiretroviral therapy.

3.2 Specific objectives:

 To assess factors affecting adherence to antiretroviral therapy among PLWH who are
on HAART follow up at Anbessamie health center, ART clinic.

8|Page
4. METHODS AND MATERIALS

4.1 Study area and period

The study was conducted at Anbessamie health center ART Clinic, which is found in south
gonder Zone of Amhara region, northwest-Ethiopia. Anbesamie is located 608Km North west
of the capital city Addis Ababa and 44Km from Bahir dar. Currently, it is giving service to
more than 45 thousand people living in dera woreda and other people nearest to this area. The
study was conducted from august to September 2021 at ART clinic of Anbesamie health
center north west ethiopia.

4.2 Study Design

A cross sectional study was conducted in Anbessamie health center, ART clinic in the study
period of august 1 to September 30, 2021.

4.3 Population

4.3.1 Source population

All RVI patients older than 18 years of age living with HIV/AIDS and on HAART those
attend ART Clinic.

4.3.2 Study population

All PLWHA who are greater than 18 years old of age on HAART and who will follow-up at
ART clinic at Anbessamie health center during the study period was included.

4.4 Eligibility criteria

4.4.1 Inclusion criteria

 All RVI Adults aged greater than 18 years.

4.4.2 Exclusion criteria

 Non responsive patients were excluded.

 All severely ill patients, patients of mental disorder and patients younger than 18
years of age.

 Naive patients those starts their ART drugs one month after was excluded.

9|Page
4.5 Study Variables

4.5.1 Dependent Variables

 Adherence of PLWH to HAART

4.5.2 Independent Variables

 Age
 Sex
 Educational level
 Marital status
 Religion
 Socio economic status
 Substance abuse
 Side effect
 Disclosure
 Duration on HAART regimen

4.6 Sample Size Determination

Since all the information was gathered from the participant themselves the
sample size would not be calculated. The sample size was included as the
patients those are attending ART clinic to refill their ART drugs during study
period.

4. 7 sampling procedure
Cconvenient sampling technique was used, since the study was cover consecutive patients
who were attend ART clinic to refill their ARV drugs over the study period.

4.8 Data collection instruments

In order to do the research structured questionnaires were prepared based on the study
objective and was designed as simple as possible to meet the aim of the research title.

4.9 Operational Definition

Adherence: The ability to start, manage, and maintain a given medication regimen at the
times, frequencies, and under specified conditions as prescribed by a health care provider.

Antiretroviral drugs: Substance used to kill or inhibit the replication of retrovirus such as
HIV.

10 | P a g e
HAART: Highly Active Antiretroviral Therapy is the name given to regimen that combines
three or more different drugs such as two nucleoside reverse transcriptase inhibitors and a
protease inhibitor (PI), two NRTIs and a no nucleoside reverse transcriptase inhibitor.

Resistance: Reduction in pathogens sensitivity to particular drug.

4.10 Data processing and Analysis

The collected data were cleared, categorized, checked for accuracy, consistency and
irregularity and then processed using manually and inserted in to data processing computer
which process the inserted raw data to necessary output. Based on which the results was
forwarded.

4.11 Data Quality Assurance

To assure quality of data, properly designed data collection instruments was developed.
Before collecting information pretest was done on some of the patients. Pretest was done on
up to 5 patients. All the collected data was reviewed and checked for completeness and
relevance by principal Investigation.

4.12 Ethical Consideration

Letter of cooperation has been written from Rift valley university collage department of
pharmacy to Anbessamie health center. The letter of cooperation was submitted to clinical
director of Anbessamie health center and permission was secured. The informed consent was
prepared. The informed consent was asked the patient before turning to other questionnaires.
All the information from the patient was kept under secret. The information should not be
told to other people for their secret.

4.13 Dissemination of the results

The finding of this study will be disseminate to Rift valley University, College of Medicine
and health Science (CMHS), department of pharmacy and to all stakeholders and academic
advisors with soft and hard copy.

11 | P a g e
5. RESULTS

5.1 Socio-demographic characteristics of the respondents

Out of total study subjects 146 (48.67%) were male and 154(51.33%) were female, most of
the respondents (50%) were between 29-39 years old. One hundred fifty nine (53%) of clients
were orthodox by religion followed by Muslim 27.33%. One hundred sixteen (38.6%)
subjects had secondary education. Most of the respondents, 210 (70%) were married.
Table 1 Socio-demographic characteristics of the respondents at Anbessamie health center
ART clinic from august 1 to September 30, 2021, Anbessamie, Amhara, Ethiopia.

Variables Frequency (n= 300) Percentage

Sex Male 146 48.67

Female 154 51.33

Age 18-28 30 10

29-39 150 50

40-50 78 26

51-61 34 11.24

>62 8 2.66

Religion Orthodox 159 53

Muslim 82 27.33

Protestant 39 13

Catholic 9 3

Other 11 3

Educational status No-education 66 22

Primary 104 34.6

Secondary 116 38.6

Tertiary 14 4.6

Marital status Single 22 7.3

Married 210 70

12 | P a g e
 Widower 24 8

Divorced 44 14.67

Occupation Employed/working 86 28.7

Unemployed 111 37

Housewife 103 34.3

Average monthly <1000 180 60

income
1000-2000 63 21

2000-5000 47 15.67

>5000 10 3.33

5.2 Duration of respondents on HAART

Most of respondents 150 (50%) are 4-7years duration on HAART while 10(3.33%) are below 1 years
(Table2).

Table 2 Duration of respondents on HAART in Anbessamie health centre ART clinic from august 1 to
September 30, 2021, Amhara, Ethiopia.

Variables Duration Total % Adherent Non-adherent

<1 years 10 3.33 9 1

1-4 years 50 16.67 47 3
4-7 years 150 50 131 19
Duration of
HAART >7 years 90 30 80 10

Total 300 100 89 33

Majority of the respondents 284(94.67%) had no HIV related hospitalization and 16(5.3%) had HIV
related hospitalization and all of them got treatment (Table3).

13 | P a g e
Table 3 Side effects faced by respondents at SRH ART clinic from august 1 to September 30,
2021, Amhara, Ethiopia.

Variable Adherent Non- Total Percent %

adherent frequency

GI upset 3 2 5 10.6
Fatigue 6 3 9 19.1
Frequent Bitter Test 5 7 11 23.4
side effect Insomnia 5 2 7 14.9
Sever Rash 3 3 6 12.8
Headache 4 1 5 10.6
Depression 0 1 1 2.3
other(*) 3 1 3 6.4

5.3 Disclosure status of the respondents.

From 300 clients 246 (82%) disclose their HIV status whereas 54(12%) didn’t disclose their HIV
status. Among those 99(33.0) of the patients disclose their HIV status to the family. (Table 4).

Table 4 Disclosure status of the respondents at SRH ART clinic from august 1 to September 30,

Disclosure status Adherent Non- Total frequency Percent (%)

adherent
Family 95 4 99 33
Relative 9 1 10 3.3
Partner 93 3 96 32
Community 39 2 41 13.7
2021, Amhara, Ethiopia.

14 | P a g e
5.4 psychiatric illness status of the respondents
Almost all of the patients didn’t have psychiatric illness 299(99.67%) and 1(0.33%) have
psychiatric illness.

0.33%

patients have pschiatric

illness
patients did'nt have ps-
chiatric illness

99.67%

Figure 1 Psychiatric illness status of the respondents in Anbessamie health center ART clinic from
august 1 to September 30, 2021, Amhara, Ethiopia.

5.5 Reason of respondent for missing the dose

Out of 300 respondents, majority of the respondents didn’t miss their dose 241(80.3%) and the rest
of them who missed their dose 59(19.7%). Majority of the respondents, 283(94.33 didn’t miss their
dose and the rest 17(5.67%) miss their dose. Those who missed their dose, 43.67% were female and
56.335% were males. Why they miss their dose i.e. forgot 4(1.33%), being too busy 3(1%), away
from home 2(0.67%), seriously ill 3(1%), problem with instruction 1(0.33%) and others 4(1.33%).

15 | P a g e
 forget
seriously ill
away from home
afraid of others

Figure 2 Reason of respondents for missing the dose in SRH ART clinic from March

20 –April20, 2017.Shashemene, West Arsi, Ethiopia

5.6 How patients compensated unscheduled drugs

Among the patients those take unscheduled drugs, 33(41.8) were taken immediately when
remembered, But 221(73.7) were not take unscheduled drugs

Table 5 how patients compensated unchanged drugs august 1 to September 30, 2021, Amhara,
Ethiopia.

Variable Frequency Percentage

Leave it 38 48.1
Taken immediately when remember 33 41.8
Other 8 10.1

16 | P a g e
5.7 Patient physician relationship
Most of the respondents 148(49.33%) had good relationship with physician and 4(1.33%) had bad
relationship with their physician (Table).

Table 6 Patient physician relationship in august 1 to September 30, 2021, Amhara, Ethiopia.

Variable Frequency Percentage

Good 148 49.33
Patient Very good 132 44
physician Excellent 16 5.33
relationship Bad 4 1.33
Total 300 100

17 | P a g e
5.8 Social drug use of the respondents
Most of the respondents 244(81.34%) didn’t use social drug and 56(18.67%) use social drug,
among these 28(50%) and 12(31.33%) use alcohol and chat respectively (Fig3).

Sales
1%

5%

Good
Very good
Excellent
Bad
49%

44%

Figure 3 Social drug use of the respondents in august 1 to September 30, 2021, Amhara,
Ethiopia.

5.9 Association of different socio-demographic Variable with adherence rate

Based on our finding 125/85%/ of males have drug adherence, while 142 /92.2%/ have good
drug adherence. So females have good drug adherence than males. On the other hand from
the study participants 22% have illiterate, 34.6% primary school, 38.6% secondary school
and 4.6% have also above secondary school. Marital status of this study shows that 7.33%,
70%, 8% and 14.67% have single, married, widowed and divorced respectively. Patient
physician relationship of this study shows that 49.33%, 44% and 1.33 have good, very good
and bad relationship respectively.(table 7)

Table 7 Association of different socio-demographic Variable with adherence rate in august 1

to September 30, 2021, Amhara, Ethiopia.

Variables Adherent Non Total percentage

adherent

Sex Male 125 21 146 48.67

Female 142 12 154 51.3

Total 267 33 300 100

18 | P a g e
Education No 56 10 66 22
status education

Primary 87 17 104 34.6

Secondary 114 2 116 38.6

Tertiary 10 4 14 4.6

Total 267 33 300 100

Marital Single 19 3 22 7.33

status
Married 190 20 210 70

Widower 22 2 24 8

Divorced 36 8 44 14.67

Total 267 33 300 100

Patient Good 128 20 148 49.33

physician
Very good 122 10 132 44
relationship
Excellent 14 2 16 5.33

Bad 3 1 4 1.33

5.10 Association of side effects, reason for missing and duration on HAART in
august 1 to September 30, 2021, Amhara, Ethiopia.

In this study bitter test (23.4%) have high side effect on other hand depression (2.3%) lest
side effects. Disclosures the patient from follow up shows that 82% have disclosure the rest
have no disclosure. The reason behind disclosure shows that seriously ill and being busy.
(table 8)

19 | P a g e
Table 8 Association of side effects, reason for missing and duration on HAART in august 1
to September 30, 2021, Amhara, Ethiopia.

Variables Adherent Non-adherent Total %

Frequent GI upset 3 2 5 10.6

side
Fatigue 6 3 9 19.1
effects
Bitter Test 5 6 11 23.4

Insomnia 5 2 7 14.9

Sever Rash 3 3 6 12.8

Headache 4 1 5 10.6

Depression 0 1 1 2.3

Other 3 1 0 6.3

Disclosure Have disclosure 226 20 246 82

Have no disclosure 41 13 54 18

Total 267 33 300 100

Reason for Busy 2 1 3 1

withdrawal
Away from home 1 1 2 0.67

Seriously ill 1 2 3 1

Problem with instruction (with meals, 0 1 1 0.33

empty stomach, etc.)

Others 3 1 4 1.33

20 | P a g e
6. DISCUSSION

Antiretroviral therapy adherence rate in the present study subjects were 80.3% based on self-
report of missed doses (dose adherence) in a one month recall, which was relatively higher
compared to the study done on HIV-patients in Guinea (78.9%) (52) .

The present study found that females 142(92.2%) were more adherent to ART than males
(85.6%). This may be due to the fact that males used social drugs which will affect adherence
negatively than females (22).

There is no gold standard for measuring adherence, and our measurement of adherence is
only based on patients’ report on missed doses; this may be subjected to social desirability
and recall bias, and literature showed that patients tend to overestimate or underestimate
adherence (21).

In the present study, a total of 300 HIV/AIDS patients who have follow up were involved in
the study, of which 154 (51.3%) were females and 146 (48.7%) were males. Similar to the
study conducted in Nigeria females were more than males (53).

The respondents who participated in this study were aged from 18 years old and above. The
majority of them were aged between 29 and 39.The study showed that the majority of the
participants were married 210 (70%) followed by divorced 44 (14.7%); this is, however,
against the national pattern. The widowed and divorced respondents (8% and 14.7%,
respectively) are much more likely to be non-adherant than those who were married and those
who have never been married (26).

The respondents’ adherence rate was inversely proportional to the length of time they had
been on ART. That is, the longer they were on ART, the lesser they adhered. But other
studies do not alike. A study done in Asia shows that the longer times on ART were
associated with improved adherence (59).

This study found that the 47 (15.7 %) of respondents had faced on drug side effects and 253
(84.3%) respondents were with no drug side effects. Bitter Test 11(24.3.%) was the most
common side effect as reported by the respondents, followed by 9(19.1%). Studies in done in
Ethiopia shows that A total of 171(26.4%) patients reported that they developed drug side
effects during the treatment. Out of these 69(40.3%) stopped taking their drugs while

21 | P a g e
102(59.7%) continued to do so correctly. Out of 381(58.9%) patients who developed multiple
signs and symptoms, 100(26.3%) had headaches, 80(21.0%) nausea, 77(20.2%) vomiting,
27(7.1%) anemia, 50(13.1%) diarrhea, and 47(12.3%) skin rash (51), medication side effects
were a significantly affect adherence in this study.

The present study found that the main reasons for missing the doses were forgetting 29
(42.7%), away from home19(27.9%),seriously ill 18 (26.5%), afraid of others 2 (2.9%). This
finding is consistent with the study conducted in Addis Ababa which indicated being too busy
or forgetting (33.9%) and being away from home (27.5%) were the commonest reasons for
missing medications. Similarly, a study done in Southwest Ethiopia also revealed that being
away from home (21.2%) and being busy (21.2%) and feeling ill (30.3%) were the common
reasons for missing medications. another study done in southwest Ethiopia shows, the principal
reasons reported for skipping doses were most 38 (43.7%) simply forget, 17 (19.5%) felt sick or ill at
that time, and 11 (12.6%) ran out of medication at baseline. During the follow up visit again the
majority 14 (65.6%) simply forgot, 4 (19%) felt sick and 4 (18%) were busy(25).

7. LIMITATIONS OF THE STUDY.

 Respondents might respond ideally rather than what practically exercise.

 Respondents consisted only of patients who actually went to ART clinics.
 Self-report alone is not enough to measure adherence.

22 | P a g e
8. CONCLUSIONS AND RECOMMENDATIONS

7.1CONCLUSIONS

Adherence rate in the present study were relatively moderate to high. There are a range of
reasons for failing to adhere to ART including, having drug side-effects, non-disclosure of
HIV status and use of social drug. The main reasons for missing of the doses were forgetting,
being too busy, being away from home and being ill.

7.2 RECOMMENDATIONS
Based on the above findings the following recommendations were forwarded to the
concerned body.

For the health workers:

 They should repeatedly assess the patients how they take, when they take and how
could adjust the missed dose etc. during follow up.
 They should encourage the patients to disclose their serostatus to maintain high level
of adherence.

For the patients:

 They should fully involve in the treatment plan so that it fits into their daily routine.

For the policy makers, NGO and Researchers:

 Policy makers need to be aware of factors affecting adherence and consider social
policy which encourages patients to achieve optimal adherence.
 Different non-governmental organization and SRH should work to decrease factors
affecting adherence
 Further study should be carried out as adherence is a dynamic behavioral and
appropriate monitoring of patients' treatment apart from adherence is required to
improve the treatment outcome.

23 | P a g e
Reference
1. JBashirZubayr, Institute of Human Virology, Nigeria ,December 15, 2014(2)
AIDSResourceCenter,FederalHIV/
AIDSPreventionandControlOffice,HIVCareandARTUpdateinEthiopia.(7)
Sebsibe Tadesse, Ayaleneh Tadesseand Mamo Wubshet, Adherence to Antiretroviral
Treatment and Associated Factors among PeopleLiving with HIV/AIDS in Northwest
Ethiopia, Institute of Public Health, The University of Gondar, Gondar, Ethiopia (51),
4 Ogbochi McKinney, Daniel Pearce, Jim Banta, Ronald Mataya, Adamson Muula4, James
Crounse, Pamela Mukaire and Pax ,Department of Health Science, California Baptist
University, Riverside, CA, USA,School of Medicine, Loma Linda University, Loma
Linda, USA,School of Public Health, Loma Linda University, Loma Linda,
USA,Department of Community Health, University of Malawi, Malawi,2016,1:3(4)
5 Mediterranean Journal of Social Sciences,MCSER Publishing, Rome-Italy,Vol 5 No
14,July 2014(6).
6 AmfAR; Delivering Resultson LGBT Research in Kenya;July2015(11).Yassin
Ibrahim1, Rosnah Sutan1, Khalib Bin AbdulLatif1, Al-Abed, Ahmed Amara Ishag
Adam, Malaysian Journal of Public Health Medicine 2014,Vol.14:90-101(12).
7 MohankumarVedhanayagam1,RajeshRajagopalan1,Balamurgan,Bhavani
Rajendran,Sendhil Sengodan ,Senthilkumar Sengodan International Journal of
Advances in Medicine, Vedhanayagam Metal. IntJAdvMed. 2016Nov;3(4):982-
988(13).
8 HanselA,BucherH,NüeschR,BattegayMReasonsfordiscontinuationoffirsthighlyactivea
ntiretroviraltherapyinacohortofproteinaseinhibitor-naiveHIV-
infectedpatients.JAcquirImmuneDeficSyndr.2001;26:191–93(14).
9 HendersonC,StonerS,PantaloneD,SimoniJ,Alcoholuseandantiretroviraladherence:revi
ewandmeta-analysis.JAcquirImmuneDeficSyndr.(200952:180–202(15)
10 Bello, S. I.HIV/AIDS Patients’ Adherence To Antiretroviral Therapy In Sobi
Specialist Hospital, Ilorin, Nigeria Global Journal of Medical research Volume 11
Issue 2 Version 1.0 July (50)
11 Markos.E,Alemayehu.W&Davey.G,Adherence to ART in PLWH A at Yirgalem
Hospital,South Ethiopia.Ethiopian Journal ofHealth Development.2008;22(2):174(21.
12 Umar Muhammad Lawan, GboluwagaTaiwo Amole, Mahmoud GamboJahun2, Janet
EneAbute , Psychosocial challenges and adherence to antiretroviral therapy among
HIV-positive adolescents attending an ART center in Kano, northwestern Nigeria,
Department of Community Medicine, Bayero University and Aminu Kano Teaching
Hospital, Kano State, , Nigeria.(19)
13 GLORIA NKOMO.A STUDY TO EXPLORE FACTORS THAT INFLUENCE ADHERENCE TO
ANTIRETROVIRAL THERAPY AMONG HIV AND AIDS ADULT PATIENTS ATTENDING
ANTIRETROVIRAL CLINIC AT BEATRICE ROAD INFECTIOUS DISEASE HOSPITAL, HARARE,
ZIMBABWE;JUNE 2014(31)
14 NDEKUSARA MAKISHE. SOCIAL FACTORS ASSOCIATED WITH ADHERENCE AND
NON ADHERENCE TO ANTI RETROVIRAL THERAPY AMONG PEOPLE LIVING WITH
HIV/AIDS: CASE STUDY AT THREE ANTIRETROVIRAL CENTRES IN DAR ES SALAAM
(ILALA, TEMEKE AND MWANANYAMALA) 2013(33)
15 Professor Damen Haile Mariam (Addis Ababa Univesity, School of Public Health)
and Professor Amy Tusi (John Hopkins University, Bloomberg School of Public
Health) ; Effect of Perceived Social Support, Depression Symptoms, and Stigma on
24 | P a g e
 Adherence and Treatment Outcome of Highly Active Antiretroviral Therapy at
Zewditu Memorial Hospital, Addis Ababa University, College Of Health Sciences,
School Of Public Health Addis Ababa, Ethiopia June 2012 (44)
16 Pruitt, Zachary, "The Determinants of Antiretroviral Therapy Adherence and the
Relationship of Healthcare Expenditures to Adherence among Florida Medicaid-
insured Patients Diagnosed with HIV or AIDS" (2013).(47)
17 Umar Muhammad Lawan, GboluwagaTaiwo Amole, Mahmoud GamboJahun, Janet
EneAbute , Psychosocial challenges and adherence to antiretroviral therapy among
HIV-positive adolescents attending an ART center in Kano, northwestern Nigeria
Department of Paediatrics, Bayero University and Aminu Kano Teaching
Hospital,Kano State, Nigeria, June , 2015(53)
18 Mills,E. J. B. Nachega, I. Buchan et al., “Adherence to antiretroviral therapy in sub-
Saharan Africa and North America: a meta-analysis,” Journal of the American
Medical Association.2006; 296( 6):679–690.(22)
19 Awachana Jiamsakul, Nagalingeswaran Kumarasamy, Rossana Ditangco, Patrick CK
Li ,Praphan Phanuphak,Thira Sirisanthana, Somnuek Sungkanuparph, Pacharee
Kantipong, Christopher KC Lee, Mahiran Mustafa,Tuti Merati, Adeeba
Kamarulzaman, Thida Singtoroj and Matthew Law, Factors associated with
suboptimal adherence to antiretroviral, Journal of the International AIDS Society
2014,17:18911(59).
20 Janet Gare, Angela Kelly-Hanku, Claire E. Ryan, Matthew David, Petronia Kaima,
Ulato Imara, Namarola Lote, SuzanneM. Crowe, Anna C. Hearps, Factors Influencing
Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the
Highlands of Papua New Guinea,RESEARCH ARTICLE,2015(52) ,
21 Amberbir, A, Woldemichael, K, Getachew, S, Girma, B &Deribe, K. Predictors of
adherence to antiretroviral therapy among HIV-infected persons: a prospective study
in Southwest Ethiopia. BMC Public Health 8:265. Doi: 2008;5
22 Mills,E.J.B.Nachega,I.Buchanetal.,“Adherencetoantiretroviraltherapyinsub-
SaharanAfricaandNorthAmerica:ameta-
analysis,”JournaloftheAmericanMedicalAssociation.2006;296(6):679–690.(22)
23 CentralStatisticalAgency.Ethiopiademographicandhealthsurvey,AddisAbaba.2012;3:2
31-44(17).
24 Adefolalu, A.,Nkosi, Z., Olorunju, S.,Masemola, P. (2014). Self-efficacy, medication
beliefs and adherence to antiretroviral therapy by patients attending a health facility in
Pretoria. South African Family Practice, 56(5), 281-285.(9) .
25 Deribe, Hailekiros, Biadgilign, Amberbir and Beyene Undertook in Jimma University
Specialized Hospital in Southwest Ethiopia.2008: 329(19)

25 | P a g e
 RIFT VALLEY UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCE

DEPARTMENT OF PHARMACY

Verbal Consent Form

Sir madam Good morning/afternoon;

My name is____________________. I am BSc student from Rift valley University. As part

of our academic requirements, I am expected to conduct a research. The study is on
Assessment of factors affecting adherence to antiretroviral therapy among Patients live with
HIV /AIDS who are on HAART follow up at Anbessamie health center, ART clinic. Thus
this interview is prepared for this purpose to get appropriate information on the topic. The
information that will be obtained using this interview will be used only for research purpose
and also confidentiality is assured. Therefore, I am politely requesting your cooperation to
participate in this interview. You do have the right not to respond at all or to withdraw in the
meantime, but your input has great value for the success of the objectives of the research.

26 | P a g e
 ሪፍት ቫሊ ዩኒቨርሲቲ

የቃለመጠይቅ ስምምነት ቅፅ

አቶ/ወ/ሮ/ሪት እንደምን አደርክ/ዋልክ

ስሜ ------------------------------------ ይባላል፡፡ እኔ በሪፍት ቫሊ ዩኒቨርስቲ የድግሪ ተማሪ ነኝ፡፡ እንደ

አካዳሚያዊ መስፈርቶቻችን አንድ ጥናት እንዳደርግ ይጠበቃል፡፡ ጥናቱ ከኤች.አይ.ቪ /ኤድስ ጋር የሚኖሩ
ህሙማን የፀረ ኤች.አይ.ቪ /ኤድስ መድሃኒት ህክምናን የሚነኩ ሁኔታዎችን በመገምገም በአንበሳሜ ጤና
ጣቢያ ኤአርቲ ክሊኒክ የሚዳሰስ ነው፡፡ ስለዚህ ይህ ቃለ መጠይቅ በርእሱ ላይ ተገቢውን መረጃ ለማግኘት
ለዚሁ አላማ የተዘጋጀ ነው፡፡ ይህንን ቃለ መጠየቅ በመጠቀም የሚገኘው መረጃ ለምርምር ዓላማ የሚውል
ብቻ ሲሆን ሚስጥራዊነቱም የተረጋገጠ ነው፡፡ስለዚህ በዚህ ቃለ መጠይቅ ላይ እንድትሳተፉ ትብብራችሁን
እተይቃለሁ፡፡በቃለ መጠይቁ ወቅት የማይመች ሁኔታ ሲገጥመዎት ምንም ምላሽ አለመስጠት ወይም
ማቋረጥ ይችላሉ ነገር ግን የእርስዎ ግብዓት ለጥናቱ ዓላማዎች ስኬት ትልቅ ጠቀሜታ አለው፡፡

27 | P a g e
Data collection format

Socio-Demographic and socio-economic variables

1. Sex: Male □ Female
2. Age:---------------------
3. Level of education: □ No education □ Primary Secondary □
Tertiary
4. Marital status: □Never married □ Married Divorced
□widow/widower
5. Religion :□ Muslim □ Orthodox Protestant □ Catholic □
Other
6. Occupation: □ Housewife □Employed/Working □
Unemployed
7. Average monthly income: □<1000 ETBR □ 1000- 2000 ETBR □
2000-5000ETBR□ More than 5000 ETBR
DISESE CHARACTERISTICS (Disease factors)
1 How long it has been taking ART drugs? ………………….. (Years or months)
2 .Duration after knowing HIV sero status (in weeks)
3 Initial HAART regimen in code ……………..
4 Number of pills taken in a day? Once twice thrice
5 Does any side effects faced? □ Yes □ No
6 If yes what are side effects? □ GI upset □ fatigue □bitter taste
□ insomnia □Severe rash □ headache □ depression
□ other
7 Does she/he have HIV-related hospitalization currently? □ Yes □ No
8 Does the patient have baseline OIS Yes No
9 She/he has taken any treatment for OIs? □Yes □ no
10 Did he/she take Cotrimoxazole prophylaxis before ART? Yes No
PSYCHOSOCIAL HISTORY (Family support and illness factors)
1. Is there disclosure? □Yes □ No
2. If yes disclosure to □partner □community □family
□relative
3. Is the family of s/he aware of HIV status? □Yes □No □Don’t know
4. If Yes, do they taking antiretroviral medication Yes No
5. Do they help you take your medication? □ A lot □ Somewhat □ A little
□Never □Not applicable
6. Have they ever been treated for a psychiatric illness? □ Yes □ No
Adherence to ART
1. Is their missed dose in the last seven days (one or more doses)? □ Yes □
No
2. If yes what number of doses missed in the last seven days. …………… doses
3. The reason for missing the dose □ Forget □ seriously ill □ away from
home busy □ afraid of others □ Problem with instruction (with meals,
empty stomach, etc) □ due to side effects others.
4. Have your drug regimen changed? Yes No
5. Relationship with your physician □Good □very good □excellent
□bad
28 | P a g e
 6. Was a drug taken out of schedule? □Yes □ No
7. If yes, how does it be compensated the unscheduled drug? □ Taken
immediately when remember □ Leave it □ Others
8. Substance abuse taken by the patient? □ Yes □ No
9. If yes which one? □ Alcohol □ chat □ tobacco □
others
10. If no what is your reason? □ Cost □Drug interaction □ others

29 | P a g e
 ቃለ መጠይቅ
የስነ -ህዝብና ኢኮኖሚያዊ መረጃ
1. ፆታ □ ወንድ □ ሴት
2. እድሜ ----------------
3. የት/ት ሁኔታ □ ያልተማረ □ አንደኛ ደረጃ ት/ት □ሁለተኛ ደረጃ ት/ት □ ሶስተኛ ደረጃ
ት/ት
4. የጋብቻ ሁኔታ □ ያላገባ □ያገባ □ የፈታ □ የሞተበት
5. ሃይማኖት □ ሙስሊም □ ኦርቶዶክስ □ ፕሮቴስታንት □ ካቶሊክ □ ሌላ
6. የስራ ሁኔታ □ የቤት እመቤት □ የመንግት ሰራተኛ □ ሥራ አጥ
7. አማካይ ወራዊ ገቢ □ ‹ 1000 ብር □ 1000-2000 ብር □ 2000-5000 ብር □ › 5000
ብር
የበሽታዎች ሁኔታ
1. የኤች አይ ቪ መድሃኒት ለስንት ጊዜ ወስደዋል? ------------------------- ኣመት/ወር
2. ዔች አይ ቪ በደምዎ ውስጥ መኖሩን መቼ ነው ያወቁት? -----------
3. የኤች አይ ቪ መድሃኒት ኮድ -------------
4. ምን ህል መድሃኒት በቀን ይወስዳሉ? □ አንድ □ ሁለት □ ሶስት
5. የጎንዮሽ ችግር ገጥሞዎት ያውቃል? □ አዎ □ የለም
6. የተራ ቁጥር 5 መልስ አዎ ከሆነ የገጠመዎ ችግር ምን ነበር □ ድካም ድካም ማለት □መራራ
ጣእም □ እንቅልፍ ማጣት □ የሰውነት ቁስለት □ እራስ ምታት □ድብርት □ ሌላ
7. ከኤች አይቪ ጋር በተያያዘ በቅርቡ ሆስፒታል ገብተሽ/ህ ታውቃለሽ/ህ □ አዎ □ የለም
8. መጀመሪያ ላይ የተዛማጅ ችግሮች መድሃኒት ወስደሽ/ህ ነበር □ አዎ □ የለም
9. የተዛማጅ ችግሮች መድሃኒት ትወስዳለህ/ሽ □ አዎ □ የለም
10. የኮትሪሞግዛዞል መድሃኒት ወስደህ/ሽ ታውቃለህ/ሽ □ አዎ □ የለም

ሳይኮሶሻል ታሪክ /የቤተሰብ ድጋፍና የህመም ምክንያቶች/

1. ስለ በሽታዎ በግልፅ ይፋ አድርገዋል? □ አዎ □ የለም

2. የተራ ቁጥር 1 መልስ አዎ ከሆነ ለማን አሳወቁ □ ለቤተሰብ □ ለህብረተሰብ
□ ለወላጅ □ ለባለቤቴ
3. ቤተሰብዎ ስለ ኤች አይ ቪ ግንዛቤ አላቸው □ አዎ □ የለም □
አላውቅም
4. የተራ ቁጥር 3 መልሱ አዎ ከሆነ ስለ መድሀኒቱ አውርተው ያውቃሉ □ አዎ
□ የለም
5. መድሃኒቱን እንዲወስዱ ይረዱዋታል □ በጣም □ አልፎአልፎ □ በትንሹ
□ ምንም □ ተግባራዊ አይደለም
6. የስነ አእምሮ ህክምና ታክመው ያውቃሉ □ አዎ □ የለም

የመድሃኒቱ አቀባበል በተመለከተ

1. በባለፈው 5 ቀናት ውስጥ ያልወሰዱት መድሃኒት □ አለ □ አዎ □ የለም

30 | P a g e
 2. መልሱ አዎ ከሆነ ምን ያክል መድሃኒት አቋረጡ ----------------------------
3. በምን ምክንያት መድሃቱ ተቋረጠ □ በመርሳት □ በጤና በመታመም □
ከቤት ውጭ ባለ ስራ ቢዚ መሆን □ ሌሎችን በመፍራት □
ምክር አገልግሎት ችግር □ በጎንዮሽ ችግር
4. መድሃኒቱ ሁኔታ ተቀይሯል □ አዎ □ የለም
5. ከሀኪምዎ ጋር ያለዎት ግንኙነት □ ጥሩ □ በጣም ጥሩ □ እጅግ በጣም
ጥሩ □ መጥፎ
6. ከፕሮግራም ውጭ መድሃኒት ወስደው ያውቃሉ □ አዎ □ የለም
7. መልሱ አዎ ከሆነ እንዴት አድርገው ያካክሱታል □ እንዳስታወስኩ መውሰድ እተወዋለሁ
□ ሌላ
8. ሌላ ሱስ አለበዎ □ አዎ □ የለም
9. መልሱ አዎ ከሆነ የትኛውን አይነት □ አልኮል □ ጫት □ ቱባኮ □ ሌላ
10. መልሱ አልዎስድም ከሆነ ለምን □ ውድ ስለሆነ □ ከመድሃኒቱ ጋር ስለሚቃረን □
ሌላ

31 | P a g e