Adherence to antiretroviral therapy and its determinants among persons living with HIV/AIDS in Bayelsa state, Nigeria
Background: A high level of adherence is required to achieve the desired outcomes of antiretroviral therapy. There is paucity of information about adherence to combined antiretroviral therapy in Bayelsa State of southern Nigeria.
Objectives: The objectives of the study were to determine the level of adherence to combined antiretroviral therapy among the patients, evaluate the improvement in their immune status and identify reasons for sub-optimal adherence to therapy.
Methods: The cross-sectional study involved administration of an adapted and pretested questionnaire to 601 consented patients attending the two tertiary health institutions in Bayesla State, Nigeria: The Federal Medical Centre, Yenagoa and the Niger-Delta University Teaching Hospital Okolobiri. The tool was divided into various sections such as socio-demographic data, HIV knowledge and adherence to combined antiretroviral therapy. Information on the patient's CD4+ T cells count was retrieved from their medical records. Adherence was assessed by asking patients to recall their intake of prescribed doses in the last fourteen days and subjects who had 95-100% of the prescribed antiretroviral drugs were considered adherent.
Results: Three hundred and forty eight (57.9%) of the subjects were females and 253 (42.1%) were males. The majority of them, 557 (92.7%) have good knowledge of HIV and combined anti-retroviral therapy with a score of 70.0% and above. A larger proportion of the respondents, 441 (73.4%), had ≥95% adherence. Some of the most important reasons giving for missing doses include, “simply forgot” 147 (24.5%), and “wanted to avoid the side-effects of drugs” 33(5.5%). There were remarkable improvements in the immune status of the subjects with an increment in the proportion of the subjects with CD4+ T cells count of greater than 350 cells/mm3 from 33 (5.5%) at therapy initiation to 338 (56.3%) at study period (p<0.0001).
Conclusion: The adherence level of 73.4% was low which calls for intervention and improvement. The combined antiretroviral therapy has significantly improved the immune status of the majority of patients which must be sustained. “Simply forgot” was the most important reason for missing doses.
2. World Health Organization. Global Health Observatory (GHO) data HIV/AIDS 2015 http://www.who.int/gho/hiv/en/ (accessed on January 9, 2016).
3. Joint United Nations Programme on HIV/AIDS (UNAIDS). Report on the Global AIDS Epidemic; 2013 World Population Data Sheet.The Joint United Nations Programme on HIV/AIDS; 2013.
4. NACA, 2012. National Agency for the Control of AIDS (NACA). Global AIDS Response: Country Progress Report: National Agency for the Control of AIDS,Abuja, Nigeria GARPR 2012.
5. The National HIV/AIDS and Reproductive Health Survey-plus. The Federal Ministry of Health, Nigeria 2012, Abuja, Nigeria.
6. Centers for Disease Control and Prevention (CDC). “HIV and its Transmission” 2003. Centers for Disease Control and Prevention, Atlanta, GA 30329-4027 USA. Available at: http://www.cdc.gov/hiv/basics/transmission.html (accessed on February 26, 2015).
7. Centers for Disease Control and Prevention (CDC). HIV/AIDS surveillance report, 2001;13(2):145.
8. World Health Organization. Adherence to long-term therapies. “evidence for action 2003. Available at: http://www.who.int/chroniccondition/adherencereport/en/ (accessed on February 20, 2014).
9. Murphy DA, Roberts KJ, Martin DJ, Marelich W, Hoffman D. Barriers to antiretroviral adherence among HIV-infected adults. AIDS Patient Care STDS. 2000;14(1):47-58.
10. Chesney MA. The elusive gold standard. Future perspectives for HIV adherence assessment and intervention. J Acquir Immune Defic Syndr. 2006;43 Suppl 1:S149-S155.
11. Shigdel R, Klouman E, Bhandari A, Ahmed LA. Factors associated with adherence to antiretroviral therapy in HIV-infected patients in Kathmandu District, Nepal. HIV AIDS (Auckl). 2014;6:109-116. doi: 10.2147/HIV.S55816
12. Machtinger EL, Bangsberg DR. Adherence to HIV Antiretroviral Therapy. 2005. Available from: http://hivinsite.ucsf.edu/InSite?page=kb-00&doc=kb-03-02-09 (accessed Jan 12, 2016).
13. Chkhartishvili N, Rukhadze N,Svanidze M,Sharvadze L, Dehovitz JA,Tsertsvadze T, McNutt L, del Rio C. Evaluation of multiple measures of antiretroviral adherence in the Eastern European country of Georgia. J Int AIDS Soc. 2014;17:18885. doi: 10.7448/IAS.17.1.18885
14. New York State Department of Health AIDS Institute. Pharmacists: Partners in Health Care for HIV-Infected Patients 2006 http://www.hivguidelines.org/clinical-guidelines/hiv-and-pharmacy/pharmacists-partners-in-health-care-for-hiv-infected-patients/ (accessed January 5, 2016).
15. Bangsberg DR. Preventing HIV antiretroviral resistance through better monitoring of treatment adherence. J Infect Dis. 2008;197 Suppl 3:S272-S278. doi: 10.1086/533415
16. World Bank. World Bank GDP per capita 2014. http://www.data.worldbank.org/indicator/NY.GPD.PCAP.CD (accessed September 6, 2014).
17. Reynolds NR, Testa MA, Marc LG, Chesney MA, Neidig JL, Smith SR, Vella S, Robbins GK; Protocol Teams of ACTG 384, ACTG 731 and A5031s. Factors influencing medication adherence beliefs and self-efficacy in person’s naïve to antiretroviral therapy. A multicentre, cross-sectional study: AIDS Behav. 2004 Jun;8(2):141-150.
18. Amico KR, Toro-Alfonso J, Fisher JD. An empirical test of the information, motivation and behavioural skills model of anti-retroviral therapy adherence. AIDS Care. 2005 Aug;17(6):661-673.
19. Remien RH, Bastos FI, Jnr VT, Raxach JC, Pinto RM, Parker RG, Berkman A, Hacker MA. Adherence to antiretroviral therapy in a context of universal access in Rio de Janeiro, Brazil: AIDS Care. 2007;19(6):740-748.
20. Weiser S, Wolfe W, Bangsberg D. Barriers to antiretroviral Adherence to patients living with HIV infection and AIDS in Botswana. J Acquir Immune Defic Syndr. 2003;34(3):281-288.
21. Byakika-Tusiime J, Oyugi JH, Tumwikirize WA, Katabira ET, Mugyenyi PN, Bangsberg DR. Adherence to HIV antiretroviral therapy in HIV+ Ugandan patients purchasing therapy. Int J STD AIDS. 2005;16(1):38-41.
22. Eholié SP, Tanon A, Polneau S, Ouiminga M, Djadji A, Kangah-Koffi C, Diakité N, Anglaret X, Kakou A, Bissagnené E. Field adherence to highly active antiretroviral therapy in HIV-infected adults in Abidjan, Côte d'Ivoire. J Acquir Immune Defic Syndr. 2007;45(3):355-358.
23. Chabikuli NO, Datonye DO, Nachega J, Ansong D. Adherence to Antiretroviral Therapy, Virologic Failure and Workload at the Rustemburg Provincial Hospital. S Afr Fam Pract (2004) 2010;52(4):350-355.
24. Mohammed MD. Adherence to antiretroviral drugs in North Central Zone of Nigeria. East Centr Afr J Pharm Sci. 2004;7(3):52-55.
25. Iliyasu Z, Kabir M, Abubakar IS, Babashani M, Zubair ZA. Compliance to antiretroviral therapy among AIDS patients in Aminu Kano Teaching Hospital, Kano, Nigeria. Niger J Med. 2005;14(3):290-294.
26. Nwauche CA, Erhabor O, Ejele OA, Akani CI. Adherence to antiretroviral therapy among HIV-infected subjects in a resource limited setting in Niger-Delta of Nigeria. Afr J Health Sci. 2006;13(3-4):13-17.
27. Erah PO, Arute JE. Adherence of HIV/AIDS Patients to Antiretroviral Therapy in a Tertiary Health Facility in Benin City. Afr J Pharmacy Pharmacol. 2008;2:145-152.
28. Olowookere SA, Fatiregun AA, Akinyemi JO, Bamgboye AE, Osagbemi GK. Prevalence and determinants of nonadherence to highly active antiretroviral therapy among people living with HIV/AIDS in Ibadan, Nigeria. J Infect Dev Ctries. 2008;2(5):369-372.
29. Afolabi MO, Ijadunola KT, Fatusi AO, Olasode OA. Determinants of Adherence to Antiretroviral Drugs among People Living with HIV/AIDS in the Ife-ijesha Zone of Osun State, Nigeria. Afr J Prim. Healthcare Fem Med. 2009;1(1):1-6. doi: 10.4102/phcfm.v1i1.6
30. Pennap GR, Abdullahi U, Bako IA. Adherence to highly active antiretroviral therapy and its challenges in people living with human immunodeficiency virus (HIV) infection in Keffi, Nigeria. J AIDS HIV Res. 2013;5(2):52-58.
31. Mukhtar-Yola M, Adeleke S, Gwarzo D, Ladan ZF. Preliminary investigation of adherence to antiretroviral therapy among children in Aminu Kano Teaching Hospital, Nigeria. Afr J AIDS Res. 2006;5(2):141-144. doi: 10.2989/16085900609490374
32. Uzochukwu BS, Onwujekwe OE, Onoka AC, Okoli C, Uguru NP, Chukwuogo OI. Determinants of non-adherence to subsidized anti-retroviral treatment in southeast Nigeria. Health Policy Plan. 2009;24(3):189-196. doi: 10.1093/heapol/czp006
33. Chesney MA, Ickovics JR, Chambers DB, Gifford AL, Neidig J, Zwickl B, Wu AW. Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). AIDS Care. 2000 Jun;12(3):255-266.
34. Bello SI. HIV/AIDS patients’ adherence to antiretroviral therapy in Sobi Specialist hospital, Ilorin, Nigeria. Glob J Med Res. 2011;11:16-25.
35. Olisah VO, Baiyewu O, Sheikh TL. Adherence to highly active antiretroviral therapy in depressed patients with HIV/AIDS attending a Nigerian University hospital clinic. Afr J Psychiatry (Johannesbg). 2010;13(4):275-279.
36. Mills EJ, Nachega JB, Buchan I, Orbinski J, Attaran A, Singh S, Rachlis B, Wu P, Cooper C, Thabane L, Wilson K, Guyatt GH, Bangsberg DR. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: A meta-analysis JAMA. 2006;296(6):679-690.
37. Nemes MI, Carvalho HB, Souza MF. Antiretroviral therapy adherence in Brazil. AIDS. 2004 Jun;18(Suppl 3):S15-S20.
38. Fisher JD, Amico KR, Fisher WA, Cornman DH, Shuper PA, Trayling C, Redding C, Barta W, Lemieux AF, Altice FL, Dieckhaus K, Friedland G; LifeWindows Team. Computer-based intervention in HIV clinical care setting improves antiretroviral adherence: the LifeWindows Project. AIDS Behav. 2011;15(8):1635-1646. doi: 10.1007/s10461-011-9926-x
39. Groh K, Audet CM, Baptista A, Sidat M, Vergara A, Vermund SH, Moon TD.. Barriers to antiretroviral therapy adherence in rural Mozambique. BMC Public Health. 2011;11:650. doi: 10.1186/1471-2458-11-650
40. Habib AG, Shepherd JC, Eng MK, Babashani M, Jumare J, Yakubu U, Gebi UI, Saad M, Ibrahim H, Blatter WA. Adherence to antiretroviral therapy (ART) during Muslin Ramadan Fasting. AIDS Behav. 2009;13(1):42-45. doi: 10.1007/s10461-008-9412-2
41. Wasti SP, van Teijlingen E, Simkhada P, Randall J, Baxter S, Kirkpatrick P, Gc VS. Factors influencing adherence to antiretroviral treatment in Asian developing countries: a systematic review. Trop Med Int Health. 2012;17(1):71-81. doi: 10.1111/j.1365-3156.2011.02888.x
42. Rickles NM, Brown TA, McGivney MS, Snyder ME, White KA. Adherence: a review of education, research, practice, and policy in the United States. Pharm Pract (Granada) 2010;8(1):1-17.