Abstract
The adherence of antiretroviral therapy (ART) higher than 95 % is needed for the effectiveness
of HIV suppression. prevention of opportunistic infections, reduction chance of HIV transmission
and overall health improvement. Aim of the study was to find facility factors related to adherence of
ART under the universal coverage. Methods: A cross-sectional study was conducted among 823 HIVinfected
individuals who were receiving antiretroviral under National AIDS Program (NAP) in 9 public
hospitals in 3 provinces (3 regional and 6 community hospitals). Adherence had been assessed by pill
count and self-report using Visual analog scale (VAS). This study was approved by ethical committee of
the Ministry of Public Health. Results and discussion: Average adherence from pill-counts and selfreport
was 87.4% and 49.7 % respectively. Adherence from regional and community hospitals evaluated
using pill-count respectively was 82.7 % and 95.2 % while using self-report respectively was 46.3 % and
56.5 %. Logistic regression model shows community hospitals were correlated with higher adherence
than regional hospital from self-report by VAS (OR=1.51; 95 % CI:1.13 -2.02, p=0.006) and from pill-counts
(OR=4.17; 95 % CI:2.10-8.31, p<0.001). Although ART service in all hospitals was under the same Universal
Coverage scheme, the difference of adherence is existed. Related factors might be from patient-staff
relationship, ease of travel, ART-one-stop service and exclusively isolate clinic in small hospitals while in
large hospitals there are many patients visited under limited service area and not separated from other
clinics for receiving ART. Conclusion(s): Regional/general hospital might need substantial supports on
budget and personnel as well as the allocation of service space and increasing interest of the clients on
adherence on ART.
