Adherence to Antiretroviral and Cancer Chemotherapy, and Associated Factors Among Patients with HIV-cancer Co-morbidity at the Uganda Cancer Institute: a Cross Sectional Study

Overview

Journal BMC Public Health

Publisher Biomed Central

Specialty Public Health

Date 2023 Jul 28

PMID 37507710

Authors

Caroline Achieng

Nelson Bunani

Joseph Kagaayi

Fred Nuwaha

Affiliations

Soon will be listed here.

Abstract

Background: Human Immunodeficiency Virus is a major global public health issue affecting millions of people, and sub-Saharan Africa where Uganda lies is disproportionately affected. There has been an increase in cancer among HIV patients which has resulted into use of co-medications that sometimes affect ART and cancer chemotherapy adherence. We aimed to determine adherence to antiretroviral and cancer chemotherapy and the associated factors among patients with HIV-cancer co-morbidity at the Uganda Cancer Institute.

Methods: We conducted a cross-sectional study among 200 randomly selected adult cancer patients infected with HIV and attending the Uganda cancer institute. Antiretroviral and anti-cancer chemotherapy adherence with associated factors were assessed quantitatively. We collected the data using interviewer administered semi-structured questionnaires. Modified Poisson regression with robust standard errors was used to estimate the prevalence ratios (PR) and its 95% confidence intervals (CI) for the factors associated with adherence to Antiretroviral Therapy (ART) and cancer chemotherapy.

Results: Overall, 54% of the study participants adhered to both ART and chemotherapy, and 55% adhered to ART while 65% adhered to cancer chemotherapy. The mean age of the respondents was 42 (SD ± 11years), and a majority, 61% were males.More than half, 56.5% were married and at least 45% had attained a primary level of education. Patients with good adherence to antiretroviral therapy and chemotherapy were 54%. No knowledge of cancer stage (PR = 0.4, 95% CI = 0.3-0.6, P < 0.0001), having an AIDS defining cancer (PR = 0.7, 95% CI = 0.5-0.9, P = 0.005), ART clinic in district not near Uganda Cancer Institute (PR = 0.7,95% CI = 0.8-1.0, P = 0.027) and affordability of cancer chemotherapy (PR = 1.4, 95% CI = 1.0-1.9, P = 0.037) were associated with adherence to both ART and cancer chemotherapy.

Conclusion: Adherence to both ART and cancer chemotherapy was low. Factors significantly associated with adherence were: knowledge of the cancer stage by the patient, the type of cancer diagnosis, source of ART and affordability/ availability of medications. There is a need to provide information on the stage of cancer and adherence counseling to patients. Furthermore, Integration of HIV- cancer care will be necessary for efficient and effective care for the patients.

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References

Burua A, Nuwaha F, Waiswa P . Adherence to standards of quality HIV/AIDS care and antiretroviral therapy in the West Nile Region of Uganda. BMC Health Serv Res. 2014; 14:521. PMC: 4239403. DOI: 10.1186/s12913-014-0521-5. View

Menon M, Coghill A, Mutyaba I, Phipps W, Okuku F, Harlan J . Association Between HIV Infection and Cancer Stage at Presentation at the Uganda Cancer Institute. J Glob Oncol. 2018; 4:1-9. PMC: 6180750. DOI: 10.1200/JGO.17.00005. View

Mitiku H, Abdosh T, Teklemariam Z . Factors affecting adherence to antiretroviral treatment in harari national regional state, eastern ethiopia. ISRN AIDS. 2013; 2013:960954. PMC: 3773384. DOI: 10.1155/2013/960954. View

Gonzalez Lopez-Valcarcel B, Librero J, Garcia-Sempere A, Pena L, Bauer S, Puig-Junoy J . Effect of cost sharing on adherence to evidence-based medications in patients with acute coronary syndrome. Heart. 2017; 103(14):1082-1088. PMC: 5566093. DOI: 10.1136/heartjnl-2016-310610. View

DiMatteo M . Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Med Care. 2004; 42(3):200-9. DOI: 10.1097/01.mlr.0000114908.90348.f9. View

Iihara H, Fujii H, Yoshimi C, Yamada M, Suzuki A, Matsuhashi N . Control of chemotherapy-induced nausea in patients receiving outpatient cancer chemotherapy. Int J Clin Oncol. 2015; 21(2):409-418. PMC: 4824820. DOI: 10.1007/s10147-015-0908-2. View

Partridge A, Archer L, Kornblith A, Gralow J, Grenier D, Perez E . Adherence and persistence with oral adjuvant chemotherapy in older women with early-stage breast cancer in CALGB 49907: adherence companion study 60104. J Clin Oncol. 2010; 28(14):2418-22. PMC: 2881723. DOI: 10.1200/JCO.2009.26.4671. View

Makanjuola T, Taddese H, Booth A . Factors associated with adherence to treatment with isoniazid for the prevention of tuberculosis amongst people living with HIV/AIDS: a systematic review of qualitative data. PLoS One. 2014; 9(2):e87166. PMC: 3911939. DOI: 10.1371/journal.pone.0087166. View

Menon M, Coghill A, Mutyaba I, Okuku F, Phipps W, Harlan J . Whom to treat? Factors associated with chemotherapy recommendations and outcomes among patients with NHL at the Uganda Cancer Institute. PLoS One. 2018; 13(2):e0191967. PMC: 5794100. DOI: 10.1371/journal.pone.0191967. View

10.

Yeam C, Chia S, Tan H, Kwan Y, Fong W, Seng J . A systematic review of factors affecting medication adherence among patients with osteoporosis. Osteoporos Int. 2018; 29(12):2623-2637. DOI: 10.1007/s00198-018-4759-3. View

11.

Barillet M, Prevost V, Joly F, Clarisse B . Oral antineoplastic agents: how do we care about adherence?. Br J Clin Pharmacol. 2015; 80(6):1289-302. PMC: 4693496. DOI: 10.1111/bcp.12734. View

12.

Jin Z, Liu X, Ding Y, Zhang Z, He N . Cancer risk factors among people living with HIV/AIDS in China: a systematic review and meta-analysis. Sci Rep. 2017; 7(1):4890. PMC: 5501798. DOI: 10.1038/s41598-017-05138-x. View

13.

Greer J, Amoyal N, Nisotel L, Fishbein J, MacDonald J, Stagl J . A Systematic Review of Adherence to Oral Antineoplastic Therapies. Oncologist. 2016; 21(3):354-76. PMC: 4786357. DOI: 10.1634/theoncologist.2015-0405. View

14.

Chen C, Chung C, Wang L, Lin C, Lin H, Lin H . Risk of cancer among HIV-infected patients from a population-based nested case-control study: implications for cancer prevention. BMC Cancer. 2015; 15:133. PMC: 4369071. DOI: 10.1186/s12885-015-1099-y. View

15.

Patel K, Foster N, Farrell A, Le-Lindqwister N, Mathew J, Costello B . Oral cancer chemotherapy adherence and adherence assessment tools: a report from North Central Cancer Group Trial N0747 and a systematic review of the literature. J Cancer Educ. 2013; 28(4):770-6. PMC: 3815511. DOI: 10.1007/s13187-013-0511-z. View

16.

Bourmaud A, Henin E, Tinquaut F, Regnier V, Hamant C, Colomban O . Adherence to oral anticancer chemotherapy: What influences patients' over or non-adherence? Analysis of the OCTO study through quantitative-qualitative methods. BMC Res Notes. 2015; 8:291. PMC: 4490730. DOI: 10.1186/s13104-015-1231-8. View

17.

Torres H, Mulanovich V . Management of HIV infection in patients with cancer receiving chemotherapy. Clin Infect Dis. 2014; 59(1):106-14. PMC: 4305124. DOI: 10.1093/cid/ciu174. View

18.

Nabukeera-Barungi N, Elyanu P, Asire B, Katureebe C, Lukabwe I, Namusoke E . Adherence to antiretroviral therapy and retention in care for adolescents living with HIV from 10 districts in Uganda. BMC Infect Dis. 2015; 15:520. PMC: 4647509. DOI: 10.1186/s12879-015-1265-5. View

19.

Morisky D, Green L, Levine D . Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care. 1986; 24(1):67-74. DOI: 10.1097/00005650-198601000-00007. View

20.

Antol D, Casebeer A, Khoury R, Michael T, Renda A, Hopson S . The relationship between comorbidity medication adherence and health related quality of life among patients with cancer. J Patient Rep Outcomes. 2018; 2:29. PMC: 6091619. DOI: 10.1186/s41687-018-0057-2. View