CLINICAL RESEARCH
Assessment of factors contributing to adherence to antiretroviral therapy among people living with HIV: our experiences from a local missionary hospital in southeastern Nigeria
Submission date: 2018-02-22
Final revision date: 2018-04-30
Acceptance date: 2018-06-25
Publication date: 2018-08-07
Arch Med Sci Civil Dis 2018;3(1):73-80
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Acquired immune deficiency syndrome (AIDS) has ceased to be dreadful, and is now considered a manageable chronic disease since the introduction of antiretroviral therapy (ART). Its goal is to achieve maximal and long-lasting suppression of viral replication. A high level of adherence is essential for effective ART, and there are many factors contributing to adherence in patients on ART. The objective of our study was to determine the level of adherence and factors influencing adherence to ART among people living with HIV.
Material and methods:
The study was conducted in the ART center at Bishop Shanahan Hospital from November to December 2017. Patients attending the ART center were included in the study. A cross-sectional study was conducted among HIV-positive patients using a well-structured questionnaire. The data collected were analyzed using SPSS version 16.0. Binary logistic regression was performed to identify associations between factors and adherence.
Results:
Although the predictors were non-significant (i.e. p > 0.05), age, gender, taking alcohol and herbal medicine, and having no medication reminder were found to be predictors of non-adherence in our study. Major reasons for missing pills were forgetfulness due to being busy (71.4%), giving up hope (26.2%) and lack of food (21.4%).
Conclusions:
Adherence to antiretroviral treatment in the ART center was sub-optimal. Patients on ART should be counseled adequately and appropriately before initiating antiretroviral treatment. Patient education must be enforced at all levels of care.
Acquired immune deficiency syndrome (AIDS) has ceased to be dreadful, and is now considered a manageable chronic disease since the introduction of antiretroviral therapy (ART). Its goal is to achieve maximal and long-lasting suppression of viral replication. A high level of adherence is essential for effective ART, and there are many factors contributing to adherence in patients on ART. The objective of our study was to determine the level of adherence and factors influencing adherence to ART among people living with HIV.
Material and methods:
The study was conducted in the ART center at Bishop Shanahan Hospital from November to December 2017. Patients attending the ART center were included in the study. A cross-sectional study was conducted among HIV-positive patients using a well-structured questionnaire. The data collected were analyzed using SPSS version 16.0. Binary logistic regression was performed to identify associations between factors and adherence.
Results:
Although the predictors were non-significant (i.e. p > 0.05), age, gender, taking alcohol and herbal medicine, and having no medication reminder were found to be predictors of non-adherence in our study. Major reasons for missing pills were forgetfulness due to being busy (71.4%), giving up hope (26.2%) and lack of food (21.4%).
Conclusions:
Adherence to antiretroviral treatment in the ART center was sub-optimal. Patients on ART should be counseled adequately and appropriately before initiating antiretroviral treatment. Patient education must be enforced at all levels of care.
REFERENCES (34)
1.
Oguntibeju OO. Quality of life of people living with HIV and AIDS and antiretroviral therapy. HIV AID (Auckl) 2012; 4: 117-24.
2.
Pujari S, Patel A, Gangakhedkar R, Kumarswamy N, Gupta SB. Guildelines for use of antiretroviral therapy for HIV infected individual in India (ART Guidelines 2008). J Assoc Phys India 2008; 56: 339-67.
3.
Cooper RD, Wiebe N, Smith N, Keiser P, Naicker S, Tonelli M. Systematic review and meta-analysis: renal safety of tenofovir disoproxil fumerate in HIV-infected patients. Clin Infect Dis 2010; 51: 496-505.
4.
Spire B, Duran S, Souville M, et al. Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: from a predictive to a dynamic approach. Soc Sci Med 2002; 54: 1481-96.
5.
Wagner GJ. Predictors of antiretroviral adherence as measured by self-report, electronic monitoring, and medication diaries. AIDS Pat Care STDS 2002; 16: 599-608.
6.
Hinkin CH, Hardy DJ, Mason KI, et al. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS 2004; 18 Suppl 1: S19-25.
7.
Sodergard B, Halvarsson M, Brannstrom J, et al. A comparison between AACTG Adherence Questionnaire and the 9-item Morisky Medication Adherence Scale in HIV-patients. Eighth International Congress on Drug Therapy in HIV Infection, Glasgow, UK 2006.
8.
Schneider J, Kaplan SH, Greenfield S, et al. Better physician-patient relationships are associated with higher reported adherence to antiretroviral therapy in patients with HIV infection. J Gen Intern Med 2004; 19: 1096-103.
9.
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24: 67-74.
10.
Morisky DE, Ward HJ, Liu KY. Self-reported medication taking behaviour: a valid indicator for assessing compliance. Presentation at the 129th American Public Health Association Meeting, Atlanta; 2001.
11.
Viswanathan H, Anderson R, Thomas J 3rd. Nature and correlates of SF-12 physical and mental quality of life components among low-income HIV adults using an HIV service center. Qual Life Res 2005; 14: 935-44.
12.
Viswanathan H, Anderson R, Thomas J 3rd. Evaluation of an antiretroviral medication attitude scale and relationships between medication attitudes and medication nonadherence. AIDS Pat Care STDS 2005; 19: 306-16.
13.
Mhaskar R, Alandikar V, Emmanuel P, et al. Adherence to antiretroviral therapy in India: a systematic review and meta-analysis. Indian J Commun Med 2013; 38: 74-82.
14.
Hogg RS, Yip B, Chan KJ, et al. Rates of disease progression by baseline CD4 cell count and viral load after initiating triple-drug therapy. JAMA 2001; 286: 2568-77.
15.
Morgan D, Mahe C, Mayanja B, Okongo JM, Lubega R, Whitworth JAG. HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries? AIDS 2002; 16: 597-603.
16.
Edward JM, Jean BN, Iain B, et al. Africa and North America: adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA 2006; 296: 679-90.
17.
Cauldbeck MB, O’Connor C, O’Connor M, Saunders JA, Rao B, Mallesh VG. Adherence to anti-retroviral therapy among HIV patients in Bangalore, India. AIDS Research Therapy 2009; 6: 7.
18.
Safren SA, Kumarasamy N, James R, Raminani S, Solomon S, Mayer KH. ART adherence, demographic variables and CD4 outcome among HIV-positive patients on antiretroviral therapy in Chennai, India. AIDS Care 2005; 17: 853-62.
19.
Sarna A, Pujari S, Sengar AK, Garg R, Gupta I, Dam J. Adherence to antiretroviral therapy and its determinants amongst HIV patients in India. Indian J Med Res 2008; 127: 28-36.
20.
Kasumu LO, Balogun MR. Knowledge and attitude towards antiretroviral therapy and adherence pattern of HIV patients in southwest Nigeria. Int J Infect Control 2014; 10: i3.
21.
Srikanth BA, Reddy P, Reddy N, Hari A, Abhijeet A. Patient counselling tools for improving adherence to antiretroviral therapy. Int J Pharm Sci Res 2012; 3: 4634-9.
22.
Nachega JB, Stein DM, Lehman DA, et al. Adherence to antiretroviral therapy in HIV-infected adults in Soweto, South Africa. AIDS Res Hum Retroviruses 2004; 20: 1053-6.
23.
Wanchu A, Kaur R, Bamberry P, Singh S. Adherence to generic reverse transcriptase inhibitor-based antiretroviral medication at a tertiary centre in North India. AIDS Behav 2007; 11: 99-102.
24.
Manteuffel M, Williams S, Chen W, Verbrugge RR, Pittman DG, Steinkellner A. Influence of patient sex and gender on medication use, adherence, and prescribing alignment with guidelines. J Women’s Health 2014; 23: 112-9.
25.
Schulz R, Sherwood PR. Physical and mental health effects of family cregiving. Am J Nurs 2008; 10: 23-7.
26.
Garavalia L, Garavalia B, Spertus JA, Decker C. Medication Discussion Questions (MedDQ): developing a guide to facilitate patient-clinician communication about heart medications. J Cardiovasc Nurs 2011; 26: E12-9.
27.
Kowalska JD, Pietraszkiewicz E, Firlag-Burkacka E, Harban A. Suspected unexpected and other adverse reactions to antiretroviral drugs used as post-exposure prophylaxis of HIV infection – five-year experience from clinical practice. Arch Med Sci 2018; 14: 547-53.
28.
Peltzer K, Pengpid S. Socioeconomic factors in adherence to HIV therapy in low- and middle-income countries. J Health Popul Nutr 2013; 31: 150-70.
29.
Falagas ME, Zarkadoulia EA, Pliatsika PA, Panos G. Socioeconomic status (SES) as a determinant of adherence in HIV infected patients: a systematic review of the literature. Retrovirology 2008; 5: 13.
30.
Nsimba SED, Irunde H, Comoro C. Barriers to ARV adherence among HIV/AIDS positive persons taking anti-retroviral therapy in two Tanzanian regions 8-12 months after program initiation. J AIDS Clin Res 2010; 1: 111.
31.
Mutwa PR, Van Nuil JI, Asiimwe-Kateera B, et al. Living situation affects adherence to combination antiretroviral therapy in HIV-infected adolescents in Rwanda: a qualitative study. PLoS One 2013; 8: e60073.
32.
Braithwaite RS, Bryant KJ. Influence of alcohol consumption on adherence to and toxicity of antiretroviral therapy and survival. Alcohol Res Health 2010; 33: 280-7.
33.
Conen A, Fehr J, Glass TR, et al. Self-reported alcohol consumption and its association with adherence and outcome of antiretroviral therapy in Swiss HIV Cohort Study. Antivir Ther 2009; 14: 349-57.
34.
Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence: review and meta-analysis. J Acquir Immune Defic Syndr 2009; 52: 180-202.
| ISSN: | 2451-0637 |
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