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

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Abstract Background: Human Immunodeficiency Virus is a major global public health issue affecting millions of people, and sub-Saharan Africa where Uganda lies is 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, attending Uganda cancer institute. Antiretroviral and anti-cancer chemotherapy adherences 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 prevalence ratios at 95% confidence intervals for factors associated with adherence to ART and cancer chemotherapy.Results: Overall, 54% (107/200) of the study participants adhered to both ART and chemotherapy, and 55% (110/200) adhered to ART while 65% (129/200) adhered to cancer chemotherapy. A majority, 61% (122/200) of the respondents were males. The mean age of the respondents was 42(SD±11years), and at least 43% (86/200) belonged to protestant religion. More than half, 56.5% (113/200) were married and at least 45% (90/200) had attained a primary level of education. Patients with good adherence to antiretroviral therapy and chemotherapy were 107(54%, 95% CI=46.5-60.4). No knowledge of cancer stage (PR=0.4, 95% CI=0.25-0.56, P<0.0001), having an AIDS defining cancer (PR=0.7, 95% CI=0.50-0.88, P=0.005), ART clinic in district not near Uganda Cancer Institute (PR=0.7,95% CI=0.84-0.96, P=0.027) and affordability of cancer chemotherapy (PR=1.4, 95% CI=1.02-1.87, 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 need to provide information on 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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