Correlates of ART adherence among Male Sex Workers (MSW) in Kenya

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.