Abstract:
Given the relevance of antiretroviral therapy (ART) treatment
to improving life expectancy and preventing the spread of drugresistant
strains, many studies have attempted to predict causes of
adherence and non-adherence in order to design strategies that
reduce the number of missed doses. Methodologically, there is
growing agreement that patients’ self-assessments of adherence—
through interviews or self-administered questionnaires—show
significant correlation with viral load tests. Little is known about
the level of ART adherence among male sex workers (MSW) in
Kenya; particularly in Nairobi. This study was aimed to determine
the level of adherence to antiretroviral therapy and associated
factors among MSW.
Methods
A cross-sectional study was conducted in Nairobi County, Kenya
targeting male sex workers living with HIV and on antiretroviral
therapy in Nairobi Kenya. A total of 260 MSWs were recruited
through a combination of chain referrals and venue-based
sampling. Data was analyzed using STATA software version 12
and the magnitude of association between the different variables in
relation to adherence to ART was assessed through the chi square
test and the fisher exact test. The results were presented using
appropriate frequency and percentage numbers. Odds ratios were
used to present both binary and multivariate models.
Results
Based on a composite criterion to establish self-reported nonadherence,
60% (158) were found non-adherent with 40% (104)
adherent. Socio-demographic variables (Age; Education level;
Religious denomination; Marital status) were not associated with
self-reported adherence. However the subject’s main reason for
getting into sex work (p=0.0017) and knowledge status (p=0.045)
were associated with self-reported adherence. Multivariate logistic
analysis showed some of the factors such as younger MSW (19-
24) (aOR: 2.1: CI: 0.5-9.5); post-secondary education (aOR: 3.9:
CI: 0.8-19.5); belonging to the Muslim religion (aOR: 2.1: CI: 0.4-
12; living in Nairobi for more than 5 years (aOR: 1.3: CI: 0.4-3.7);
reporting sex work as a main source of income (aOR: 8.9: CI:2.8-
38.2); Having an average income of less than Ksh 1000 (aOR: 3.7:
0.2-65.9); having a single sexual partner (aOR:2 CI: 0.5-12.2);
never been arrested because of sexual identity (aOR: 1.7: CI: 0.9-
2.8); being knowledgeable about HIV and ART (aOR: 2.1CI: 1.4-
3.8) were more likely to be adherent.
Conclusion
The adherence rates found in the MSW are lower than those of
men in the general population. Adherence is a complex issue which
requires multiple approaches to address fully. Efforts to improve the
level of adherence for this group require a collaborative approach
involving the patient, the MSW community, health workers, and
policy makers to address the structural constraints of adherence.