Substance use literacy, adherence to HIV medication and addiction severity among adult substance users in Naivasha district hospital (Kenya)

Abstract

Substance use knowledge has been found to be low among substance users despite numerous substance awareness campaigns. This presents a worrying trend considering that substance use is a major impediment to HIV medication adherence. Studies done on the association between health literacy and HIV medication adherence have given mixed results. However, the impact of substance use literacy on HIV medication adherence is yet to be known. This study embarked on finding out if there is a significant relationship between substance use literacy and adherence to HIV medication and whether severity of addiction modified this relationship. A cross-sectional study among 179 HIV infected substance users was carried out whereby Questionnaire Assessment of Literacy in Mental Health, Addiction Severity Test and 8-item Morisky Medication Adherence Scale psychometric tests were administered. Data was coded and analyzed using SPSS version 20. Descriptive statistics were used to calculate frequencies and chi-square was used to calculate significant correlations. Data was presented in the form of tables, pie charts and narratives. Results showed 50.3% of the respondents wrongly identified the alcohol use vignette problem as stress. Not recognizing that there was a problem was significantly correlated to moderate adherence (P = 0.003). Among the severely addicted, there was a clear association between low adherence and not recognizing substance use as vignette problem. Preference was given to informal sources of help like a close friend (83.2%, P = 0.050) and psychosocial management like physical exercise (79.9%, P = 0.007) other than professionals like psychiatrists (58.1%) leading to moderate adherence and addiction severity. Though 81% of the severely addicted recognized a psychiatrist could help, 61.9% of them had low adherence. The same inverse relationship was exhibited in recognizing effective medication like antidepressants. Poor substance use literacy was found to lead to poor adherence with severe addiction modifying this relationship.