Medication adherence, out of pocket expenditures and their association among patients with sickle cell disease attending SCD clinic at Mulago National Referral Hospital, Kampala

Abstract

Sickle cell disease (SCD) is a significant global health concern, particularly prevalent in Africa and Latin America, with rising incidences and prevalence rates. The burden of SCD extends beyond its medical challenges, encompassing substantial economic impacts, primarily driven by OOP expenditures. These costs, often exceeding 40% of individuals' capacity to pay for healthcare, lead to catastrophic expenditures and economic strain, especially in regions with limited healthcare resources like Uganda. Despite the high OOP costs associated with SCD treatment, there is limited literature on this topic in Uganda. Additionally, adherence to SCD medications presents challenges influenced by various factors such as socioeconomic status, patient-provider communication, and healthcare access. Studies from other countries highlight varied adherence rates across different treatment regimens, emphasizing the need for tailored interventions to improve adherence and reduce economic burdens on PLSCD and their families. This study aims to delve into the magnitude of OOP expenditures and their association with medication adherence among PLSCD (CDC, 2023; Thomson et al., 2023; Mubyazi & Njunwa, 2011; WHO, 2023; Johnson et al., 2023; Amarachukwu et al., 2022; CEHURD, 2022; Loiselle et al., 2016; Phillips et al., 2022). Methods: A cross-sectional study was conducted among 338 SCD patients attending the SCD clinic at Mulago National Referral Hospital. Data on sociodemographic characteristics, clinical history, OOP expenditures, and medication adherence were collected through structured interviews and medical records review. Adherence was assessed using the Morisky Medication Adherence Scale-8 (MMAS-8), and OOP expenditures were recorded in Ugandan Shillings. Results: The majority of patients were male (50.9%) with a median OOP expenditure of UGX 200,000 (interquartile range: UGX 100,000-300,000). Adherence to SCD medications was poor, with 78% of patients being non-adherent. Higher OOP expenditures were significantly associated with lower medication adherence (adjusted prevalence ratio [aPR] 1.29, 95% CI: 1.118-1.484, p < 0.001). Female patients exhibited higher non-adherence rates (aPR 0.85, 95% CI: 0.702-0.901, p < 0.001) compared to males. Patients spending >500,000 UGX (aPR 1.28, 95% CI: 1.124-1.457, p < 0.001) had higher non-adherence rates. Conclusion: Our findings underscore the significant impact of OOP expenditures on medication adherence among PLSCD in Uganda. Higher financial burdens were associated with poorer adherence, highlighting the need for interventions to alleviate economic strain and improve adherence rates.