Prevalence and Determinants of Adherence to Highly Active AntiRetroviral Therapy Amongst People Living with HIV/AIDS in a Rural Setting in South-South Nigeria

Afiong O. Oku, Eme T. Owoaje, Oboko O. Oku, Emmanuel Monjok


Adherence to HAART is necessary to achieve the best virologic response and lower the risk of drug resistance amongst People living with HIV/AIDS (PLHIV). However, there is limited documentation of adherence amongst patients on HAART in the south-south region of Nigeria. This study aimed to determine the prevalence and determinants of adherence to HAART amongst PLHIV in a rural setting in Cross River State. A descriptive cross-sectional study was conducted among 393 patients on HAART attending the Heart to Heart centre Ugep using an interviewer-administered questionnaire.  Adherence was measured via self report and patients were termed adherent if they took at least 95% of prescribed doses. The self reported adherence rate based on a one week recall was 50.4%. The main reason for skipping doses were being busy (50.6%), simply forgetting to take medications (43.8%) and religious constraints (16%). Perceived improved health status [OR 2.7; CI: 1.37-5.39], Non use of herbal remedies, [OR 1.8; 95% CI: 1.23- 2.64] and ARV regimens devoid of dietary instructions [OR 1.49; 95% CI: 1.07- 2.06] were significant predictors of adherence. The adherence rate reported in this study was low. Appropriate adherence enhancing intervention strategies targeted at use of simplified ARV regimens and discouraging herbal use is strongly recommended. (Afr J Reprod Health 2014; 18[1]: 133-144).

Keywords: Adherence, PLHIV, HAART, rural setting, Nigeria.



Adhérence thérapeutique est nécessaire pour atteindre la meilleure réponse virologique et réduire le risque de résistance aux médicaments chez les personnes vivant avec le VIH / SIDA (PVVIH). Cependant, il y a peu de documentation de l'adhésion chez les patients en multi thérapie (TARHA) dans la région sud-sud du Nigeria. Cette étude visait à déterminer la prévalence et les déterminants de l'adhérence à la multi thérapie antirétrovirale chez les PVVIH en milieu rural  de l’État de Cross River. Une étude descriptive transversale a été menée auprès de 393 patients en multi thérapie qui fréquentent le Heart to Heart Centre à Ugep à l'aide d'un questionnaire administré par un intervieweur. L'adhérence a été mesurée à travers des auto-déclarations par les patients. On a qualifié d’adhérents ceux qui ont pris au moins 95 % des doses prescrites. Le taux d’adhérence d’âpres l’auto déclaration  basé sur un rappel d'une semaine était de 50,4 %. Les principales raisons de sauter des doses comprenaient le fait

d’être  occupés (50,6 %), d’oublier tout simplement de prendre des médicaments (43,8 %) et les contraintes religieuses (16%). Le statut  de la sante améliorée perçue [OR 2,7, IC : 1,37 à 5,39], non utilisation de remèdes à base de plantes, [1,8 ; IC à 95% : 1,23 à 2,64 ] et les schémas ARV dépourvu de consignes alimentaires [OR 1,49, IC 95% : 1,07 2.06] sont des indices significatifs de l'adhésion. Le taux d’adhérence rapporté dans cette étude  était faible. Nous recommandons les stratégies d'intervention  qui favorisent l’adhérence ayant comme cible  l'utilisation des traitements antirétroviraux simplifiés et qui découragent l'utilisation de médicament à base de plantes. (Afr J Reprod Health 2014; 18[1]: 133-144).

Mots clés: adhérence, PVVIH, TARHA, cadre champêtre, Nigeria.

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UNAIDS. Global HIV/AIDS Epidemic Update. Geneva, Switzerland 2011.

Federal Ministry of, Health(FMOH). 2010 National HIV sero- prevalence Senntinnel Survey. Abuja: Federal Ministry of Health 2010.

World Health Organisation(WHO). WHO African Region Nigeria2008.

Federal Ministry of Health (FMOH). National Guidelines for HIV and AIDS Treatment and Care in Adolescents and Adults. Abuja, Nigeria.Federal Ministry of Health 2010.

Rao Ds, Kekwaletswe TC, Hosek S, Martinez J, Rodriguez F, . Stigma and social barriers to medication adherence with urban youth living with HIV. AIDS Care. 2007;19(1):28-33.

Lewis MP, Colbert A, Erlen J, Meyers M. A Qualitative study of persons who are 100% adherent to antiretroviral therapy. AIDS Care 2006;18(2):140-8.

Lee L, Karon JM, Selik R, Neal JJ, Fleming P. Survival after AIDS diagnosis in adolescents and adults during the treatment era United States. Journal of the American Medical Association. 2001;285(10):1308131.

Monjok E, Smesny A, Okokon IB, Mgbere O, Essien J. Adherence to antiretroviral therapy in Nigeria: An overview of research studies and implications for policy and practice. HIV/AIDS - Research and Palliative Care 2010;2:69-76.

National Agency for the control of AIDS (NACA). Antiretroviral Therapy (ART) in Nigeria . Fact sheet 2011; 2011.

Amico KR, Toro-Alfonso J, Fisher JD. An empirical test of the Information, Motivation and Behavioural Skills model of antiretroviral therapy adherence. AIDS Care. 2005;17(6):661-73.

Remien RH, Bastos FI, Terto Jnr V, Raxach JC, Pinto RM, Parker RG, et al. Adherence to antiretroviral therapy in a context of universal access, in Rio de Janeiro, Brazil,. AIDS Care. 2007;19(6):740-8.

Reynolds NR, Testa M, Marc L, Chesney M, Neidig J, Smith S, et al. Factors influencing medication adherence beliefs and self-efficacy in persons naïve to antiretroviral therapy: a multicentre, cross-sectional study. AIDS Behaviour. 2004;8(2):141- 50.

Nozakia I, Christopher D, Kazuhiro K, Norio Y, James BS. Social factors affecting ART adherence in rural settings in Zambia. Aids care. 2011;23(7):831-8.

Wang X, Wu Z. Factors associated with adherence to antiretroviral therapy among HIV/AIDS patients in rural China. AIDS. 2007; 21 (suppl 8):149-55.

Wainberg M, Friedland G. Public health implications of antiretroviral therapy and HIV drug resistance. JAMA. 1998;279:1977–83 .

Read T, Mijch A, Fairley CK. Adherence to antiretroviral therapy: are we doing enough? Internal Medicine Journal. 2003;33(5-6): 254-6

Bartlett JA . Addressing the challenges of adherence. Journal of Acquired Immune Deficiency Syndrome. 2002;29(suppl 1):2-10.

Nwauche C, Erhabor O, Ejele O, Akani C. Adherence to Antiretroviral therapy among HIV-infected subjects in a resourcelimited setting in the Niger Delta of Nigeria. African Journal of Health Sciences. 2006; 13(3):13-7.

Olowookere SA, Fatiregun AA, Akinyemi JO, Bamgboye AE, GK. O. 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):369-72.

Erah P, Arute J. Adherence of HIV/AIDS patients to antiretroviral therapy in a tertiary health facility in Benin City. African Journal of Pharmacy and Pharmacology. 2008;2(7):145-52.

National Population Commission (NPC). National census Nigeria 2006.

Sasaki Y, Kakimoto K, Dube C, I S, Moyo C, Syakantu G, et al. Adherence to Antiretroviral therapy(ART) during the early months of treatment in rural Zambia: influence of demographic characteristics and social surroundings of patients. BMC Annals of Clinical Microbiology and Antimicrobials. 2012;11(34):1-11.

Svarstad B, Chewning B, Sleath B, Claessonc C. The brief medication questionnaire: A tool for screening patient adherence and barriers to adherence. Patient Education and Counseling 1998;37:113–24.

Paterson G, Swindells S, Mohr J. Adherence to protease inhibitor therapy and outcome in patients with HIV infection. Ann Intern Med. 2000;133:21–30.

Hogg R, Heath K, Bangsberg D, Yip B, Press N, O'Shaughnessy M, et al. Intermittent use of triplecombination therapy is predictive of mortality at baseline and after 1 year of followup. AIDS Care. 2002;16(10):51-8.

Afolabi MO, Ijadunola KT, Fatusi AO, OA. O. Determinants of adherence to antiretroviral drugs among people living with HIV/AIDS in the Ife-Ijesa of Osun State, Nigeria. African Journal of Primary Health Care and Family Medicine. 2009;1(1):6

Amberbir A, Woldemichael K, Getachew S, Girma B, Deribe K. Predictors of adherence to antiretroviral therapy among HIV-infected persons: a prospective study in Southwest Ethiopia. BMC Public Health. 2008;8(265):1-10.

Talaam NC, Gatongi P, Rotich S. Faactors Affecting Antiretroviral Drug Adherence among HIV/AIDS Adult Patients attending HIV/AIDS clinic at Moi Teaching and Refferal Hospital, Eldoret, Kenya. East African Journal of Public health. 2008;5(2):74- 8.

Wakibi SN, Ng’ang’a ZW, Mbugua GG. Factors associated with non-adherence to highly active antiretroviral therapy in Nairobi, Kenya. AIDS Research and Therapy 2011;43:1-8.

Agu KA, Okojie O, Oqua D, King RC, Omonaiye O, Onuoha C, et al. Medication Adherence and Risk factors for Non-adherence among Patients taking Highly Active Antiretroviral Therapy West African Journal of Pharmacy. 2011;22(1):19 - 26.

Mohammed MD, R. S. Adherence to antiretroviral drugs in North-Central zone of Nigeria. East and Central African Journal of Pharmaceutical Sciences. 2004;7(3):52–5.

Kleeberger C, Phair J, Strathdee S, Detels R, Kingsley L, Jacobson L. Determinants of heterogenous adherence to HIV antiretroviral therapies in the Multicentre AIDS Cohort Study. JAcquir Immune 2001;26(1):82-92.

Gifford A, Bormann J, Shively M, Wright B, Richman D, Bozzette S. Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. Journl of Acquired Immune Deficiency Syndrome. 2000;23:386-95.

Uzochukwu B, Onwujekwe O, Onoka A, Okoli C, Uguru N, Chukwuogo O. Determinants of non-adherence to subsidized anti-retroviral treatment in southeast Nigeria. Health Policy Plan. 2009;24:189–96.

Malcolm S, Ng J, Rosen R, Stone V. An examination of HIV/AIDS patients who have excellent adherence to HAART. AIDS Care. 2003;15(2):251-61.

Peltzer K, Preez NF-d, Ramlagan S, Anderson J. Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa. BMC Public Health. 2010;10:1-10.

Ibekwe NA, Iloghalu CN, Omile JN, editors. Non adherence as as challenge to a successful HIV/AIDS treatment International AIDS conference; 2010; Italy.

Bello SI. HIV Patients adherence to ART in Sobi Specialist Hospital, Illorin, Nigeria. Global Journal of Medical research. 2011;11(2):16-21.

Cauldbeck MB, O'Connor C, O'Connor MB, Saunders JA, Rao B, Mallesh VG, et al. Adherence to anti-retroviral therapy among HIV patients in Bangalore, India. AIDS Research and Therapy 2009;6(7):1-8.


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