Adherence to Antiretroviral Therapy: Who are the Defaulters? A study in a Treatment Centre in Nigeria
Keywords:
Adherence, Antiretroviral therapy, DepressionAbstract
Introduction: Non-adherence to antiretroviral therapy has remained a challenge in achieving desired goals of human immunodeficiency virus (HIV) treatment resulting in progression to acquired immunodeficiency syndrome. The objective of this study is to determine the level of adherence of HIV positive patients to antiretroviral therapy and factors associated with non-adherence.
Methods: This cross-sectional study was conducted among 266 patients receiving antiretroviral therapy in Central Hospital using pretested validated questionnaires consisting of items from the Patient Health Questionnaire-9, Adherence to Refill and Medications scale, and the Visual analog scale. Chi Square and Logistic regression using statistical soŌware SPSS 20 were used for data analysis.
Results: The mean age of those who participated in the study was 39.28±11.05 years. More females participated in the study (76.7%). Fifty-five (19.5%) patients were depressed. Half of the study participants were 100% adherent to antiretroviral therapy. The mean score on the visual analogue scale was 87.78±19.30. None of the socioeconomic factors were associated with adherence to ART, but alcohol (OR 0.477; (CI) 0.282-0.854], and depression (OR 0.416 (CI) 0.238-0.836] were statistically significant factors for non-adherence.
Conclusion: This study reveals poor adherence to antiretroviral therapy among half of the study participants. Only depressed patients and those who use alcohol were found to be defaulters in adhering to therapy. Improvement in the quality of education and counseling offered to patients on a regular basis and programs that help identify alcohol users and those at risk of depression can improve adherence in patients.
References
UNAIDS(2016) – Prevention gap report, www.unaids.org/en/resources/2016preventiongapreport Accessed on July 18th, 2017
Mulugeta A, Mekonnen A, Mulatu A, Duba J (2014). Level of ART adherence and associated factors among HIV Sero-positive adults on HAART in Debre Markos referral Hospital, North West Ethiopia S. Anti vir Antiretrovir 6: 120-126
Margaret AC (2000). Factors affecting adherence to antiretroviral therapy. Clin Infectious Diseases 30(2): 5171-5176
Falang KD, Akubaka N, Jimam NJ (2012). Patient factors impacting anti-retroviral drug adherence in a Nigerian tertiary Hosptial. J Pharmaco. Pharmacother 3 (2); 138-142.
Vreeman RC, Wiehe SE,Pearce EC, Nyandiko WM (2008). A systematic review of paediatric adherence to antiretroviral therapy in low and middle income countries. Paediatric Infectious Disease Journal 27(8):686-691
Simoni JM, Montgomery A, Martin E, New M, Demas PA, RanaS (2007). Adherence to antiretroviral therapy for paediatric HIV infection: A Qualitative systematic review with recommendations for research and clinical management. Paediatris 119(6):e1371-e1383
Ickovic IR, Meade CS (2002a). Adherence to HAART among patients with HIV: Breakthroughs and Barriers. AIDs Care 14(3):309-18
Ickovic IR, Meade CS (2002b). Adherence to anti retroviral therapy among patients with HIV. A critical link between behavior and biomedical sciences. J Acquir Immune Defic Syndr 31(3):598-602
Mathew EF, Efsthatha AZ, Paraskevi AP, George P(2008). Socioeconomic status as a determinant of adherence to treatment in HIV infected patients. A Systematic Review of the literature. Retrivirology 5:13
Agu KA, Okojie O,Oina D, King RC, Omonaye O et al (2011). Medication adherence and risk factors for non-adherence among patients taking HAART. West African Journal of Pharmacy 22(1):19-26
Kitshoff C, Campbell L, Naidoo SS (2012). The association between depression and adherence to antiretroviral therapy in HIV positive patients, KwaZulu-Natal, South Africa. South Africa Family Practice 54:2
Cruess DG, Petipto JM, Lesserman J(2003). Depression and HIV infection: Impact on immune function and disease progression. CNS Spectr 8:52-58
United States Veteran & Affair: Depression and HIV-HIV/AIDS(2009) www.hiv.va.gov/careprovidermanual/primarydepression.asp Accessed July 2017
Jeffery SG, Abigail WB, Christian P, Stephen AS(2011). Depression and HIV/AIDS treatment non-adherence: A Review and Meta-analysis. J. AIDS 58(2):10
Olalekan AU, Jessica JM, Steven AS, Jean BN (2014). Depression and adherence to antiretroviral therapy in low, medium and high-income countries: A Systematic Review and
Meta-analysis. Curr HIV/AIDS Rep. 11(3): 291-307
Afiong OK, Eme T.O, Olusimbo KI and Angela O (2013). Prevalence and determinants of adherence to ART amongst PLWHA in a tertiary health facility in south-south Nigeria. BMC Infection Diseases 13: 401
Laura Manea, Simon G (2012). Dean my optimal cut-off scores for diagnosing depression with the PHQ-9: A Meta-analysis, CMAJ. 184(3): E 191-E196.
Kurt K, Robert LS, Janet B (2001). The PHQ-9 validity of a brief depression severity measure. J Gen Intern Med. 16(9): 606-613
Teddy MC, Fredrick Y, Christine C, Henry C (2006).Using the PHQ-9 for depression screaming and treatment monitoring for Chinese Americans in Primary Care. Psychiatric Services. 57(7); 976-981.
Hyekyhung J, Yeohee K, Sandy JR (2016). Factors affecting medication adherence in elderly people: Patient Preference and Adherence 10: 2117-2125
Kripalani S, Risser J, Gath ME (2009). Development and evaluation of the adherence to refill and medications scale (ARMS) among low literacy patients with chronic disease. Value Health 12 (1) 118-123
Rivet KA, William AF, Cornman DH, Jeffery DF (2006). Visual analog scale of ART adherence J. of AIDS 42 (4): 445-459
Edward LM, David RD. Measuring adherence- hivinSite.ucsf.edu/inSite/?page=kb-03-02-09 Accessed August 2016
Jean B, Oklekan AU, Karl P, Lindsey AR et al (2015). Association between retroviral therapy and employment status: systematic review and meta-analysis. Bulletin of the World Health Organization 93:29-41.
Uzochukwu B, Onwujekme O, Onoka A, Okili .C et al (2009). Determinants of non dherence to subsidized anti-retroviral treatment in South east Nigeria. Health Policy Plan 24:189-190
Melaku AE, Tebogo MM, and Nonceba M (2016).Adherence to antiretroviral therapy among HIV and AIDs patients at the KwaThema clinic in Gauteng province of South Africal. Afr j Prim Health Care Fam Med 8(2):924
Christopher O, Peter KS, Jubilant KA, Chris O (2013). Predictors of Adherence to Anti retroviral Therapy among HIV/AIDs Patients in the Upper West Region of Ghana. ISRN AIDs 873939
Senkomago V, Guwatudde D, Breda M, Khoshnood K (2011). Barriers to antiretroviral adherence in HIV-postive patients receiving free medications in Kayunga, Uganda. AIDs Care 23(10):1246-53
Habtamu M, Tekabe A, Zelalem T (2013). Factors Affecting Adherence to ART in Harari National Regional State, Eastern Ethiopia. ISRN AIDs 960954
Braithwaithe S, Yixin F, Tate J, Sherry M et al (2016). Do alcohol misuse, Smokers and depression vary concordantly or sequentially. A longitudinal study of HIV infected and matched infected veterans in care. Aids Behav 20(3):566-572.
Shiva R, Mary EW, Susan K, Nanay R et al (2011). Cigarette smoking in the HIV-infected population. Proc am Thorac Soc 8(3): 313-319
Christian SH, Susan AS, David WP, Jane MS (2009). Alcohol use and antiretroviral adherence: A review and Meta-analysis. J Acquir Immun Defic Syndr 52(2):180
Jacquet A, Ekouevi KD, Bashi J, Maiga A et al (2015). Alcohol use and non-adherence to ART in HIV-infected pati ents in West Africa. Addiction 105(8):1416-1421
Cerutti B, Broers B, Masetsibi M, Faturiyele O et al (2016). Alcohol use and depression: Link with adherence and viral suppression in adult patients on antiretroviral therapy in rural Lesotho, Southern Africa: A cross-sectional study. BMC Public Health 16:947
Katrina MB, Penelope AD, Andrea AH, Elle EB et al (2004). Gender difference in factors associated with adherence to antiretroviral therapy. Journal of General Internal Medicine 19(11):1111-1117
Sullivan LF, Goulet JI, Amy C (2011). Alcohol consumption and depressive symptoms over time: A longitudinal study of patients with or without HIV infection, Drug Alcohol Depend 117 (2-3): 158-163
Tessa H,Joyce BL, Susan CA, Sigrid CV, Kerstin K (2016). Determinants of adherence to ART among HIV-positive adults in sub-Saharan Africa: A systematic review. BMJ Glob Health 1(4):e000125
Olisah V.O, Bayemn O, Sheikh TL(2010). Adherence to ART in depressed parents with HIV/AIDS, attending a Nigerian University teaching hospital clinic. Afr J sychiatry(Johannesburg) 13 (47:275-9)
Pleasure AN, Peter NF, Roland CN(2007). Depression among HIV/AIDS patients on HAART in the Southwest Regional Hospitals of Cameroon: Across sectional study. Neuro 6(1): 103-114
Bhatia M.S, Sahil M (2004). Prevalence of depression in people living with HIV/AIDS undergoing ART and factors associated with it. Int J. Chin Diagn Res 8 (10) wco1-wco4
Visanou H, Oatt ara S, Jo D, Vanphanom S Kongmany C et al (2013). Adherence to Anti retroviral Therapy (ART) among PLHIV: A cross-sectional survey to measure in Lao PDR. BMC Public Health 13:617
Al Dakkak I, Patel, S, McCann(2014). The Impact of Specific HIV treatment-related adviser events on adherence to ART: A systematic Review and meta-analysis. AIDs Care 25 (4): 400-414
Kekwaletswe C, Morojele N (2014). Alcohol use, anti retroviral therapy adherence, and preferences regarding an alcohol-focused adherence intervention in patients with human immunodeficiency virus. Patient Preferences and Adherence 8:401-41
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
