Factors associated with fluoxetine adherence among outpatients with common mental disorders in Western Kenya

Non-adherence to antidepressants has been linked to increased symptom severity, relapse and hospitalisation from common mental disorders. However, there is limited knowledge of factors associated with antidepressant adherence in low-income and middle-income countries, especially in public sector, primary care settings.

We quantified fluoxetine adherence using the medication possession ratio. A limitation of this measure is that it does not always reflect the ingestion of medication. We constructed a generalised estimating equations linear regression with robust SEs, clustered by the participant, to identify independent predictors of fluoxetine adherence.

Participants randomised to fluoxetine were dispensed an average of 126 daily doses, or 70% of the 180 possible doses. Adherence was higher in the first half of the treatment period at 86.3%, 95% CI (83.5% to 89.2%) compared with 46.5% in the second half (44.3% to 48.8%) (p<0.001). Participants who opted for community-delivered fluoxetine demonstrated adherence at 79.7% (77.0% to 82.4%) compared with 58.6% (55.7% to 61.5%) of those who only picked up medication at the facility (p<0.001). Use of mHealth for at least one but less than half of the visits had the highest level of adherence at 84.6% (82.4% to 86.9%) compared with 49.6% (46.1% to 53.0%) among those who did not use mHealth and 67.2% (62.5% to 72.0%) for those who used mHealth at least half their visits (p<0.001).

Adherence to fluoxetine was high relative to existing selective serotonin reuptake inhibitors adherence data, the majority of which is from high-income countries. Adherence was higher during the first half of treatment. People who were older, living with HIV and opted to use community delivery of medication and/or mHealth had higher adherence.

NCT03466346.