MAGNITUDE OF MEDICATION ADHERENCE AND ITS ASSOCIATED FACTORS AMONG POST KIDNEY TRANSPLANT PATIENTS IN ST. PAUL HOSPITAL MILLENNIUM MEDICAL COLLEGE, ETHIOPIA.

Abstract

Abstract Background: Kidney transplantation is the treatment of choice for chronic kidney disease and end stage renal disease which requires lifelong treatment with immunosuppressive medications. Strict adherence to immunosuppressant medicine regimens is key to prevent kidney rejection; however, evidence suggests that adherence is sub-optimal especially in low income countries like Ethiopia. The aim of this study was to determine the level of medication adherence and the associated factors among post-kidney transplant patients at St. Paul’s Hospital, Addis Ababa, Ethiopia. Methods: An institution based cross sectional study was conducted among 270 post-kidney transplant patients at St. Paul’s Hospital Renal Transplant Unit from October12th , 2021 to January 4th, 2022. A structured questionnaire was used for data collection. Data were entered using EpiInfo7 and analyzed using SPSS version 26 software. The prevalence of medication adherence was computed, and then binary Logistic regression model was fitted to estimate the measure of association between the outcome and explanatory variables. With COR and AOR, 95% confidence interval and p-value <0.05 statistical significance was used. Result: More than two-third (71.5%) of the patients were males. The median age of the kidney transplant patients was 37 (IQR, 28-45) years of age; and the median duration after transplant was 3.12 (IQR=1.2-5.0) years. The prevalence of medication adherence in post kidney transplant patients was 81.9% (CI=76.7-86.3). The significant associated factors for a decreased medication adherence were missing follow up visit, above five years post-transplant duration and being forgetfulness. Missing follow up visits more than two times had a 91.2% decreased adherence level as compared to those who had never missed (AOR=0.088, CI=0.028-0.278, p-value<0.0001). In patients with above five years post-transplant duration, adherence was 92.6% less as compared to one year and below (AOR=0.074, CI=0.007-0.78, p-value=0.031). Being forgetful was associated with 89.6% lowered adherence level as compared to drug unavailability as a reason for decreased adherence(AOR=0.104, CI=0.021 0.523, p-value= 0.006). Conclusion and recommendation: The prevalence of medication adherence among kidney transplant patients in Ethiopia was higher as compared to the WHO measured adherence level and other studies. The negatively associated factors with medication adherence were missing follow up visit, post-transplant duration above five years and being forgetfulness. The recommendation to health care providers working on kidney transplant patients is that to persuade patients with setting reminder/alarm, regular call notification of appointment dates. For the institution, to build a system for tracking patients and regular reminding using contact address; with special attention to patients with above five years of post-transplant. Keywords: medication adherence, associated factors, post kidney transplant, Addis Ababa, Ethiopia