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Yiryuo L, Kpekura S, Osman W, Kukeba MW, Mumuni ND, Mwinbam MM, Dery A. Challenges and support experienced by family caregivers seeking antiretroviral therapy services for children living with HIV/AIDS: a phenomenological study in Ghana. BMJ Open 2024; 14:e081036. [PMID: 38760044 PMCID: PMC11103234 DOI: 10.1136/bmjopen-2023-081036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 04/25/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND Family caregivers of children living with HIV/AIDS in most cases are found to be overwhelmed and under-resourced, yet they are believed to be the primary source of support for children living with HIV/AIDS. Family caregivers experience different challenges that affect their children's antiretroviral therapy (ART) adherence. AIM This study explored the lived experiences of family caregivers of children living with HIV/AIDS who sought ART services for these children at the St Joseph's Hospital of Jirapa, Ghana. METHOD Using a qualitative phenomenology design and a semistructured in-depth interview guide and using purposive sampling, data were gathered from 13 family caregivers of children living with HIV/AIDS receiving ART treatment at St Joseph's Hospital, Jirapa following ethical approval. All interviews were audio-taped and transcribed verbatim. Reflexive thematic analysis was used to analyse the transcribed data. FINDINGS Six themes were generated: five challenges and one support. Family caregivers of children living with HIV/AIDS experienced: (1) Financial challenges, (2) Human-related challenges, (3) Challenges at HIV testing and counselling (HTC) centres, (4) Challenges with transportation, (5) Challenges in disclosing children's HIV status to them and (6) Support received from HTC and their family members. CONCLUSION AND RECOMMENDATION Family caregivers of children living with HIV/AIDS experience daunting challenges in their quest to care for their children. Governmental and non-governmental HIV/AIDS programme support should include small business skills training and acquisition including capital to help set up small-scale businesses for such caregivers to reduce their financial challenges. Access to ART at clinics closer to caregivers is also key to promoting adherence. Family and community support has been recognised as key to enhancing ART adherence. Education of caregivers on policy regarding disclosure of the HIV/AIDS status of children, the need to work to reduce the time spent by caregivers at HTC, and ensuring privacy by limiting access to HTCs to only caregivers and their children, are important to enhancing adherence.
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Affiliation(s)
- Lilian Yiryuo
- St. Joseph's Hospital, Ghana Health Service, Accra, Jirapa, Ghana
- Pediatrics, Ghana College of Nurses and Midwives, Accra, Ghana
| | - Stephen Kpekura
- General and Preventive Health Nursing, C K Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Wahab Osman
- Department of Advance Nursing, University for Development Studies, Tamale, Northern Region, Ghana
| | - Margaret Wekem Kukeba
- Ghana College of Nurses and Midwives, Accra, Ghana
- Department of Maternal and Child Health Nursing, C K Tedam University of Technology and Applied Sciences, Navrongo, Ghana
| | - Najart Deborah Mumuni
- Ghana College of Nurses and Midwives, Accra, Ghana
- Ghana Health Service, Nadowli, Nadowli Upper West Region, Ghana
| | - Mavis Mallory Mwinbam
- Ghana College of Nurses and Midwives, Accra, Ghana
- Ghana Health Service, Accra, Nadowli Upper West Region, Ghana
| | - Anthony Dery
- NURSING, Seventh-Day Adventist Clinic, WA, GHANA, Ghana
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Nutor JJ, Gyamerah AO, Duah HO, Asakitogum DA, Thompson RGA, Alhassan RK, Hamilton A. The association of HIV-related stigma and psychosocial factors and HIV treatment outcomes among people living with HIV in the Volta region of Ghana: A mixed-methods study. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002994. [PMID: 38422060 PMCID: PMC10903797 DOI: 10.1371/journal.pgph.0002994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/12/2024] [Indexed: 03/02/2024]
Abstract
Stigma and discrimination have been identified as significant barriers to HIV treatment among people living with HIV (PLWH). HIV stigma affects decision to seek HIV testing and early treatment. Evidence shows that HIV stigma undermines antiretroviral therapy (ART) adherence by affecting the psychological process such as adjusting and coping with social support. In Ghana, stigma toward PLWH occurs in many ways including rejection by their communities and family members, ostracism, and refusal to engage in social interactions such as eating, sharing a bed, or shaking hands. Therefore. we examined PLWH's experiences with different forms of HIV-related stigma and the impact on HIV treatment outcome in the Volta region of Ghana. We employed a convergent mixed-method approach consisting of a survey with 181 PLWH, four focus group discussions with 24 survey respondents, and in-depth interviews with six providers. We performed independent samples t-test, ANOVA, and chi-square test to test associations in bivariate analysis and analyzed qualitative data using thematic analysis. In all, 49% of survey respondents reported experiencing high internalized stigma, which was associated with high social support and depression (p<0.001). In qualitative interviews, anticipated stigma was the most salient concern of PLWH, followed by internalized and enacted stigma, which all negatively impacted HIV treatment and care. Stigma was experienced on multiple levels and affected psychosocial and treatment outcomes. Findings suggest urgent need for HIV-stigma reduction intervention among PLWH and their family, providers, and community members.
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Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
| | - Akua O. Gyamerah
- Department of Community Health and Health Behavior, University of Buffalo, Buffalo, New York, United States of America
| | - Henry Ofori Duah
- College of Nursing, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - David Ayangba Asakitogum
- Department of Family Health Care Nursing, School of Nursing, University of California, San Francisco, San Francisco, California, United States of America
| | - Rachel G. A. Thompson
- Language Center, College of Humanities, University of Ghana, Accra, Ghana
- Africa Interdisciplinary Research Institute, Accra, Ghana
| | - Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Alison Hamilton
- VA Health Services Research & Development Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, United States of America
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, United States of America
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Krishnan PD, Durai RD, Veluri S, B Narayanan VH. Semisolid extrusion 3D printing of Dolutegravir-Chitosan nanoparticles laden polymeric buccal films: personalized solution for pediatric treatment. Biomed Mater 2024; 19:025046. [PMID: 38364288 DOI: 10.1088/1748-605x/ad2a3a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/16/2024] [Indexed: 02/18/2024]
Abstract
In this work, the semi solid extrusion 3D printing process was utilized to incorporate anti-HIV drug Dolutegravir and its nanoparticles into the buccal film (BF) that was fabricated using the developed polymer ink. The composite made of polyvinyl alcohol (PVA) and sodium alginate was processed into a 3D printing polymer ink with optimum viscosity (9587 ± 219 cP) needed for the seamless extrusion through the nozzle of the 3D printer. The formulated BFs were assessed for its physical properties like weight (0.414 ± 0.3 g), thickness (1.54 ± 0.02 mm), swelling index (18.5 ± 0.91%), and mucoadhesiveness strength (0.165 ± 0.09 N) etc, The structural integrity and the surface morphology of the developed BFs were investigated by scanning electron microscopy analysis. The chemical stability and the solid-state nature of the drug in the BFs were assessed by Fourier transform infrared and x-ray diffraction analysis respectively. Further the BFs were assessed for drug dissolutionin-vitroandex-vivo, to study the effect of polymer composition and printing condition on the dissolution profile of the drug in the simulated salivary fluid. The results demonstrated that the developed PVA based polymer ink for 3D printing utilizing pressure is a versatile approach in the context of manufacturing mucoadhesive BFs customized in terms of shape and the amount of drug loaded.
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Affiliation(s)
- Priya Dharshini Krishnan
- Pharmaceutical Technology Laboratory, ASK-II, Lab No: 214, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Ramya Devi Durai
- Pharmaceutical Technology Laboratory, ASK-II, Lab No: 214, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
| | - Sivanjineyulu Veluri
- Centre of Molecular and Macromolecular Studies, Polish Academy of Sciences, Sienkiewicza 112, 90-363 Lodz, Poland
| | - Vedha Hari B Narayanan
- Pharmaceutical Technology Laboratory, ASK-II, Lab No: 214, SASTRA Deemed-to-be-University, Thanjavur 613401, Tamil Nadu, India
- Centre of Molecular and Macromolecular Studies, Polish Academy of Sciences, Sienkiewicza 112, 90-363 Lodz, Poland
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Shabanova V, Emuren L, Gan G, Antwi S, Renner L, Amissah K, Kusah JT, Lartey M, Reynolds NR, Paintsil E. Pediatric HIV Disclosure Intervention Improves Immunologic Outcome at 48 Weeks: The Sankofa Trial Experience. J Acquir Immune Defic Syndr 2023; 94:371-380. [PMID: 37643414 PMCID: PMC10617661 DOI: 10.1097/qai.0000000000003292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 07/10/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND The World Health Organization recommends disclosure of HIV status to children and adolescents living with HIV (CALWH). HIV disclosure improves adherence to antiretroviral therapy and immunologic and virologic outcomes. However, the prevalence of HIV disclosure is low in sub-Saharan Africa. We assessed the longitudinal effect of the Sankofa Pediatric HIV disclosure intervention on immunologic and virologic outcomes among CALWH in Ghana. METHODS We conducted a secondary analysis of a two-arm site-randomized clinical trial among CALWH aged 7-18 years. Data were collected at baseline, 24, and 48 weeks. Generalized linear mixed models were used to compare immunologic (CD4) and virologic (viral load) outcomes as both continuous and categorical variables by disclosure status and by intervention group. RESULTS Among participants who had their HIV status disclosed during this study, the proportion with CD4 percent >25% increased from 56.5% at baseline to 75.4% at week 48 ( P = 0.03), with a slight increase in the undisclosed group (69.5% vs. 74.3%, P = 0.56). In the intervention arm, there was a steady increase in proportion with CD4 percent >25% from 47.1% at baseline to 67.8% at week 48 ( P = 0.01) while it remained unchanged in the control arm (80.5% vs. 81.3% [ P = 0.89]). Concurrently, declines in detectable viral load were observed in both disclosed (63.3% vs. 51.5%, P = 0.16) and undisclosed (69.9% vs. 62.0%, P = 0.17) groups while the intervention group experienced a meaningful drop from 72.9% to 57.6% at 24 weeks ( P = 0.04), which was maintained at 48 weeks. CONCLUSIONS A structured, culturally relevant disclosure intervention can improve clinical outcomes.
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Affiliation(s)
| | - Leonard Emuren
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Geliang Gan
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, USA
| | - Sampson Antwi
- Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Lorna Renner
- Department of Child Health, University of Ghana Medical School and Korle-Bu Teaching Hospital Accra, Ghana
| | - Kofi Amissah
- Department of Child Health, School of Medical Sciences, Kwame Nkrumah University of Science and Technology and Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Jonas Tettey Kusah
- Department of Child Health, University of Ghana Medical School and Korle-Bu Teaching Hospital Accra, Ghana
| | - Margaret Lartey
- Department of Medicine, University of Ghana Medical School and Korle-Bu Teaching Hospital Accra, Ghana
| | | | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
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Alhassan RK, Nutor JJ, Gyamerah A, Boakye-Yiadom E, Kasu E, Acquah E, Doe E. Predictors of HIV status disclosure among people living with HIV (PLHIV) in Ghana: the disclosure conundrum and its policy implications in resource limited settings. AIDS Res Ther 2023; 20:84. [PMID: 38012668 PMCID: PMC10680271 DOI: 10.1186/s12981-023-00569-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/29/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Globally, over 40 million lives have been claimed by HIV/AIDS. In Ghana, more than 350,000 people are living with HIV. Non-disclosure of HIV status is a major barrier to HIV/AIDS eradication; yet, little is known of the determinants of HIV status disclosure in resource limited settings in Africa like Ghana. OBJECTIVE Determine the predictors of HIV status disclosure among people living with HIV (PLHIV) and stimulate policy discourse on support systems for self-disclosure in Africa. METHODS This is a descriptive cross-sectional study among PLHIV (n = 181) in sub-Saharan Africa, specifically the Volta region of Ghana. Bivariate probit regression was run to determine factors associated with HIV status disclosure among PLHIV. RESULTS HIV status self-disclosure was reported by 50% of the respondents; nearly 65% disclosed their status to non-family members and non-partners. Significant correlates of HIV status disclosure either to partners or non-partners were marital status, monthly income, type of occupation, and being divorced due to HIV status (p < 0.05). CONCLUSIONS HIV status disclosure remains low in Ghana like many African countries. There is the need for a renewed policy debate on tailored guidelines for HIV status self-disclosure and targeted support systems for PLHIV to ameliorate their predicaments and promote eradication of the epidemic in Africa.
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Affiliation(s)
- Robert Kaba Alhassan
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana.
| | - Jerry John Nutor
- University of California San Francisco School of Nursing, San Francisco, USA
| | - Akua Gyamerah
- University of California San Francisco School of Nursing, San Francisco, USA
| | | | - Emmanuel Kasu
- School of Medicine, University of Health and Allied Sciences, Ho, Ghana
- Ho Teaching Hospital, Ministry of Health (MoH), Ho, Ghana
| | - Evelyn Acquah
- Institute of Health Research, University of Health and Allied Sciences, PMB 31, Ho, Ghana
| | - Emmanuel Doe
- Ho Teaching Hospital, Ministry of Health (MoH), Ho, Ghana
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Boadu I, Manu A, Aryeetey RNO, Kesse KA, Abdulai M, Acheampong E, Akparibo R. Adherence to antiretroviral therapy among HIV patients in Ghana: A systematic review and meta-analysis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002448. [PMID: 37910452 PMCID: PMC10619784 DOI: 10.1371/journal.pgph.0002448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/12/2023] [Indexed: 11/03/2023]
Abstract
Maintaining a high level of adherence to antiretroviral therapy (ART) is critical to limiting rapid viral replication, drug resistance, and viral transmission. However, ART adherence remains a major challenge in HIV/AIDS treatment success. This systematic review and meta-analysis was aimed to synthesize available evidence on adherence to ART among HIV/AIDS patients in Ghana.This review followed the preferred reporting item for systematic review and meta-analysis (PRISMA) criteria. A comprehensive literature search was done using five online databases (PubMed, Google Scholar, Medline, Africa Index Medicus, and Willey Online Library) from 25th- 30th April 2023 to identify potential studies. In addition, references of related articles were manually searched to further identify relevant studies. Search records were managed in Endnote library where duplicates were removed prior to screening. Studies were eligible for inclusion if they were conducted in Ghana, designed as an observational or experimental study, and explicitly measured adherence to ART, either as a primary or secondary outcome. Studies were excluded if the proportion or prevalence of adherence to ART was not reported.A total number of 126 potential studies were identified from the literature search. Of these, 14 met the inclusion criteria and were included in the Meta-analysis. The studies involved a total number of 4,436 participants. The pooled estimate of adherence to ART was 70% (CI: 58-81%). In subgroup analysis, adolescents and young adults had a lower adherence rate (66%, CI: 46-84%) compared with adults (70%; CI: 58-81%). Publication bias was not observed among studies. The pooled estimate of optimal adherence to ART among HIV patients in Ghana was lower than is recommended (≥95%) to achieve viral suppression. Adherence was lower among young persons living with HIV/AIDS. To achieve the United Nation's Sustainable development goals and the UNAIDS "95-95-95" targets, there is a need to focus on improving adherence interventions among persons living with HIV/AIDS, especially among the younger cohort.
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Affiliation(s)
- Isaac Boadu
- Department of Population, Family and Reproductive Health, School of Public Health, Legon, University of Ghana, Accra, Ghana
| | - Adom Manu
- Department of Population, Family and Reproductive Health, School of Public Health, Legon, University of Ghana, Accra, Ghana
| | - Richmond Nii Okai Aryeetey
- Department of Population, Family and Reproductive Health, School of Public Health, Legon, University of Ghana, Accra, Ghana
| | - Kwame Adjei Kesse
- Department of Population, Family and Reproductive Health, School of Public Health, Legon, University of Ghana, Accra, Ghana
| | - Marijanatu Abdulai
- Department of Epidemiology and Disease Control, School of Public Health, Legon, University of Ghana, Accra, Ghana
- Ghana National AIDS/STI Control Programme (NACP), Accra, Ghana
| | - Emmanuel Acheampong
- Institute of Precision Health, University of Leicester, Leicester, United Kingdom
| | - Robert Akparibo
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
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Yiryuo L, Osman W, Kpekura S. A phenomenological study of the beliefs of family caregivers of children living with HIV/AIDS on adherence to antiretroviral therapy. Nurs Open 2023; 10:6117-6124. [PMID: 37209366 PMCID: PMC10416031 DOI: 10.1002/nop2.1833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/01/2023] [Accepted: 05/05/2023] [Indexed: 05/22/2023] Open
Abstract
AIM To explore the beliefs of family caregivers on adherence to Anti-Retroviral Therapy (ART) among children living with HIV/AIDS that received care at St. Joseph's Hospital, Jirapa, Ghana. DESIGN A qualitative phenomenological design was employed for this study. METHOD Data was gathered using a semi-structured in-depth interview guide from 13 family caregivers of children with HIV/AIDS on ART. Analysis was done using the reflexive thematic analysis approach. RESULTS Three major themes were generated during the analysis: "Beliefs regarding the effectiveness of ART"; "Beliefs regarding taking ART"; and "Beliefs regarding other treatments for HIV/AIDS". Most caregivers believed that the ARTs were effective and improved their children's health, especially when adhered to strictly. Some, however, believed in praying to God for healing, and the use of local/herbal to augment ARTs. CONCLUSION Family caregivers generally hold positive beliefs about ARTs and its effectiveness for their children. Some, however, believe in spirits, prayers, and herbal/local treatment in addition to ARTs.
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Affiliation(s)
- Lilian Yiryuo
- St. Joseph's HospitalGhana Health ServiceJirapaGhana
- Faculty of Paediatric NursingGhana College of Nurses and Midwives (GCNM)AccraGhana
| | - Wahab Osman
- Faculty of Paediatric NursingGhana College of Nurses and Midwives (GCNM)AccraGhana
- Department of Advanced Nursing Practice, School of Nursing and MidwiferyUniversity for Development StudiesTamaleGhana
| | - Stephen Kpekura
- School of Nursing and MidwiferyC.K. Tedam University of Technology and Applied SciencesNavrongoGhana
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Owusu LB, Ababio C, Boahene S, Zakaria AFS, Emikpe AO, Dwumfour CK, Appiagyei KA, Apiribu F. The predictors of unsuppressed viremia among PLHIV: a cross-sectional study in Ghana. BMC Public Health 2023; 23:1113. [PMID: 37296400 PMCID: PMC10257285 DOI: 10.1186/s12889-023-16032-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Unsuppressed viremia in HIV infected patients is generally associated with increased rates of disease transmission and poor patient survival. This study assessed the socio-demographic determinants of People Living with HIV/AIDS, having viral load non-suppression and who are receiving antiretroviral therapy in a District Hospital in Ghana. METHODS The study utilized the cross-sectional research design with both primary and secondary data conducted from September to October 2021 in Ghana. Data were collected from 331 PLHIV who were placed on Anti-Retroviral Therapy (ART) for more than 12 months at the ART centre at a District Hospital in Ghana. Unsuppressed viremia was defined as plasma viral load of ≥ 1000 copies/mL after 12 months on an ART with effective adherent support. A structured questionnaire was used to collect primary data on participants and a Secondary data was also collected from patients' folders, hospital registers and the computerized health information systems at the study site. SPSS was used to analyse descriptive and inferential data. Pearson's chi-square and Fisher's exact test were used to assess the independent determinants of viral load non-suppression. Pearson's chi-square test was used for tests giving ≤ 20% of expected cell counts less than five while Fisher's exact test was used for tests giving > 20% of expected cell counts less than five. A p value of < 0.05 was considered statistically significant. RESULTS Out of the 331 PLHIV who participated in the study, 174 (53%) were female and 157 (47%) were Male. The study found viral load non-suppression of 19% with age (p = 0.03), income (p = 0.02), employment (p = 0.04), means of transportation (p = 0.02), cost of transportation to the ART centre (p = 0.03) and level of medication adherence (p = 0.02) as determinants of viral load non-suppression. CONCLUSION There was a low level of viral load non-suppression among PLHIV after 12 months of active antiretroviral therapy with age, income, employment, means of transportation, cost of transportation and level of medication adherence influencing viral non-suppression. Thus, ART drugs and services should be decentralized to the community health workers' level within the various localities of patients to decrease the economic consequences involved in accessing health care for PLHIV/AIDS. This will minimize defaulting, improve adherence and promote viral load suppression.
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Affiliation(s)
| | - Christiana Ababio
- New Edubiase Government Hospital, Adansi South District, Ashanti Region, Ghana
| | - Selina Boahene
- New Edubiase Government Hospital, Adansi South District, Ashanti Region, Ghana
| | | | | | | | | | - Felix Apiribu
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
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Addo MK, Aboagye RG, Tarkang EE. Factors influencing adherence to antiretroviral therapy among HIV/AIDS patients in the Ga West Municipality, Ghana. IJID REGIONS 2022; 3:218-225. [PMID: 35755462 PMCID: PMC9216268 DOI: 10.1016/j.ijregi.2022.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Antiretroviral therapy (ART) is used to suppress the HIV viral load but requires optimal adherence to be effective. This study examined the factors influencing ART adherence among HIV-positive clients in the Ga West Municipality, Ghana using the Health Belief Model (HBM). METHODS A facility-based cross-sectional design was adopted among 397 HIV clients aged 18 years and above. Data were collected using an interviewer-administered questionnaire and analysed using Stata version 16.0. Binary logistic regression was performed at the P < 0.05 level. RESULTS Adherence to ART was 44.6%. Clients who took less than 30 minutes to reach ART sites were 59% less likely to adhere to ART (odds ratio (OR) 0.41, 95% confidence interval (CI) 0.20-0.82). Clients who thought they lost income when they went to obtain their ART refill were more likely to adhere to ART (OR 1.71, 95% CI 1.04-2.83), as were those who developed side effects (OR 1.74, 95% CI 1.05-2.89) (perceived barriers). Clients who had confidence in their ability to take their medications (self-efficacy) (OR 1.86, 95% CI 1.05-3.31) and those who received reminders from health workers (cues to action) (OR 1.91, 95% CI 1.04-3.53) were more likely to adhere to ART. CONCLUSIONS Interventions should focus on increasing client confidence in adhering to ART. Providers should be empowered to provide reminders to patients.
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Affiliation(s)
- Mavis Kessewa Addo
- School of Public Health, University of Health and Allied Sciences, PMB 31 Ho, Volta Region, Ghana
| | - Richard Gyan Aboagye
- School of Public Health, University of Health and Allied Sciences, PMB 31 Ho, Volta Region, Ghana
| | - Elvis Enowbeyang Tarkang
- School of Public Health, University of Health and Allied Sciences, PMB 31 Ho, Volta Region, Ghana
- HIV/AIDS Prevention Research Network Cameroon PO Box 36 Kumba Southwest Region, Cameroon
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Edun O, Shenderovich Y, Zhou S, Toska E, Okell L, Eaton JW, Cluver L. Predictors and consequences of HIV status disclosure to adolescents living with HIV in Eastern Cape, South Africa: a prospective cohort study. J Int AIDS Soc 2022; 25:e25910. [PMID: 35543100 PMCID: PMC9092159 DOI: 10.1002/jia2.25910] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/26/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The World Health Organization recommends full disclosure of HIV-positive status to adolescents who acquired HIV perinatally (APHIV) by age 12. However, even among adolescents (aged 10-19) already on antiretroviral therapy (ART), disclosure rates are low. Caregivers often report the child being too young and fear of disclosure worsening adolescents' mental health as reasons for non-disclosure. We aimed to identify the predictors of disclosure and the association of disclosure with adherence, viral suppression and mental health outcomes among adolescents in sub-Saharan Africa. METHODS Analyses included three rounds (2014-2018) of data collected among a closed cohort of adolescents living with HIV in Eastern Cape, South Africa. We used logistic regression with respondent random-effects to identify factors associated with disclosure, and assess differences in ART adherence, viral suppression and mental health symptoms between adolescents by disclosure status. We also explored differences in the change in mental health symptoms and adherence between study rounds and disclosure groups with logistic regression. RESULTS Eight hundred and thirteen APHIV were interviewed at baseline, of whom 769 (94.6%) and 729 (89.7%) were interviewed at the second and third rounds, respectively. The proportion aware of their HIV-positive status increased from 63.1% at the first round to 85.5% by the third round. Older age (adjusted odds ratio [aOR]: 1.27; 1.08-1.48) and living in an urban location (aOR: 2.85; 1.72-4.73) were associated with disclosure between interviews. There was no association between awareness of HIV-positive status and ART adherence, viral suppression or mental health symptoms among all APHIV interviewed. However, among APHIV not aware of their status at baseline, adherence decreased at the second round among those who were disclosed to (N = 131) and increased among those not disclosed to (N = 151) (interaction aOR: 0.39; 0.19-0.80). There was no significant difference in the change in mental health symptoms between study rounds and disclosure groups. CONCLUSIONS Awareness of HIV-positive status was not associated with higher rates of mental health symptoms, or lower rates of viral suppression among adolescents. Disclosure was not associated with worse mental health. These findings support the recommendation for timely disclosure to APHIV; however, adherence support post-disclosure is important.
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Affiliation(s)
- Olanrewaju Edun
- MRC Centre for Global Infectious Disease AnalysisSchool of Public HealthImperial College LondonLondonUK
| | - Yulia Shenderovich
- Wolfson Centre for Young People's Mental HealthCardiff UniversityCardiffUK
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer)School of Social SciencesCardiff UniversityCardiffUK
- Centre for Evidence‐Based InterventionDepartment of Social Policy and InterventionUniversity of OxfordOxfordUK
| | - Siyanai Zhou
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
| | - Elona Toska
- Centre for Evidence‐Based InterventionDepartment of Social Policy and InterventionUniversity of OxfordOxfordUK
- Centre for Social Science ResearchUniversity of Cape TownCape TownSouth Africa
- AIDS and Society Research UnitUniversity of Cape TownCape TownSouth Africa
| | - Lucy Okell
- MRC Centre for Global Infectious Disease AnalysisSchool of Public HealthImperial College LondonLondonUK
| | - Jeffrey W. Eaton
- MRC Centre for Global Infectious Disease AnalysisSchool of Public HealthImperial College LondonLondonUK
| | - Lucie Cluver
- Centre for Evidence‐Based InterventionDepartment of Social Policy and InterventionUniversity of OxfordOxfordUK
- Department of Psychiatry and Mental HealthUniversity of Cape TownCape TownSouth Africa
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11
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Anakwa NO, Teye‐Kwadjo E, Kretchy IA. Illness perceptions, social support and antiretroviral medication adherence in people living with HIV in the greater Accra region, Ghana. Nurs Open 2021; 8:2595-2604. [PMID: 33626226 PMCID: PMC8363381 DOI: 10.1002/nop2.797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 11/14/2020] [Accepted: 01/29/2021] [Indexed: 11/08/2022] Open
Abstract
AIM To assess how illness perceptions and social support influence antiretroviral medication adherence in a HIV patient population in Ghana. DESIGN This study used a correlational research design with cross-sectional data. METHOD A total of 235 people living with HIV at two general hospitals in the Greater Accra Region of Ghana provided data on illness perceptions, social support and medication adherence. Hierarchical multiple regression test was used to analyse the data. RESULTS Illness perceptions' facets of timeline, personal control and treatment control were negatively associated with medication adherence, whereas emotional response was positively associated with adherence. Further, significant other support was negatively associated with adherence. Family and friend support were not associated with adherence. The findings offer preliminary evidence that illness perceptions may have utility for medication adherence in a HIV patient population in Ghana.
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Affiliation(s)
- Nella O. Anakwa
- Department of PsychologySchool of Social SciencesUniversity of GhanaLegonGhana
| | - Enoch Teye‐Kwadjo
- Department of PsychologySchool of Social SciencesUniversity of GhanaLegonGhana
| | - Irene A. Kretchy
- Department of Pharmacy Practice and Clinical PharmacySchool of PharmacyUniversity of GhanaLegonGhana
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12
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Afrane AKA, Goka BQ, Renner L, Yawson AE, Alhassan Y, Owiafe SN, Agyeman S, Sagoe KWC, Kwara A. HIV virological non-suppression and its associated factors in children on antiretroviral therapy at a major treatment centre in Southern Ghana: a cross-sectional study. BMC Infect Dis 2021; 21:731. [PMID: 34340689 PMCID: PMC8330060 DOI: 10.1186/s12879-021-06459-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Children living with human immunodeficiency virus (HIV) infection require lifelong effective antiretroviral therapy (ART). The goal of ART in HIV-infected persons is sustained viral suppression. There is limited information on virological non-suppression or failure and its associated factors in children in resource limited countries, particularly Ghana. METHODS A cross-sectional study of 250 children aged 8 months to 15 years who had been on ART for at least 6 months attending the Paediatric HIV clinic at Korle Bu Teaching hospital in Ghana was performed. Socio-demographic, clinical, laboratory and ART Adherence related data were collected using questionnaires as well as medical records review. Blood samples were obtained for viral load and CD4+ count determination. Viral load levels > 1000 copies/ml on ART was considered virological non-suppression. Logistic regression was used to identify factors associated with virological non-suppression. RESULTS The mean (±SD) age of the study participants was 11.4 ± 2.4 years and the proportion of males was 53.2%. Of the 250 study participants, 96 (38.4%) had virological non-suppression. After adjustment for significant variables, the factors associated with non-suppressed viral load were female gender (AOR 2.51 [95% CI 1.04-6.07], p = 0.041), having a previous history of treatment of tuberculosis (AOR 4.95 [95% CI 1.58-15.5], p = 0.006), severe CD4 immune suppression status at study recruitment (AOR 24.93 [95% CI 4.92-126.31], p < 0.001) and being on a nevirapine (NVP) based regimen (AOR 7.93 [95% CI 1.58-1.15], p = 0.005). CONCLUSION The prevelance of virological non-suppression was high. Virological non-suppression was associated with a previous history of TB treatment, female gender, severe CD4 immune suppression status at study recruitment and being on a NVP based regimen. Early initiation of ART and phasing out NVP-based regimen might improve viral load suppression in children. In addition, children with a history of TB may need focused measures to maximize virological suppression.
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Affiliation(s)
- Adwoa K A Afrane
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana.
| | - Bamenla Q Goka
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana.,Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Lorna Renner
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana.,Department of Child Health, University of Ghana Medical School, Accra, Ghana
| | - Alfred E Yawson
- Department of Community Health, University of Ghana Medical School, Legon, Accra, Ghana
| | - Yakubu Alhassan
- Department of Health Policy Planning and Management, School of Public Health, University of Ghana, Legon, Accra, Ghana
| | - Seth N Owiafe
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
| | - Seth Agyeman
- Department of Immunology, Korle Bu Teaching Hospital, Accra, Ghana
| | - Kwamena W C Sagoe
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Awewura Kwara
- Department of Medicine, University of Florida, College of Medicine, Gainesville, Florida, USA
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13
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Abdulai MA, Mevissen FEF, Ruiter RAC, Owusu‐Agyei S, Asante KP, Bos AER. A qualitative analysis of factors influencing antiretroviral adherence among persons living with
HIV
in Ghana. JOURNAL OF COMMUNITY & APPLIED SOCIAL PSYCHOLOGY 2021. [DOI: 10.1002/casp.2551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Martha Ali Abdulai
- Kintampo Health Research Centre, Ghana Health Service Kintampo Ghana
- Department of Work and Social Psychology Maastricht University Maastricht The Netherlands
| | - Fraukje E. F. Mevissen
- Department of Work and Social Psychology Maastricht University Maastricht The Netherlands
| | - Robert A. C. Ruiter
- Department of Work and Social Psychology Maastricht University Maastricht The Netherlands
| | - Seth Owusu‐Agyei
- Kintampo Health Research Centre, Ghana Health Service Kintampo Ghana
- Institute of Health Research University of Health and Allied Sciences Ho Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Ghana Health Service Kintampo Ghana
| | - Arjan E. R. Bos
- Faculty of Psychology Open University Heerlen The Netherlands
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14
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Klutsey DA, Amankwah‐Poku M, Oppong Asante K. To disclose or not to disclose? Caregivers experiences of disclosure of HIV status of children living with HIV in Accra, Ghana. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | - Kwaku Oppong Asante
- Department of Psychology University of Ghana, Legon Accra Ghana
- Department of Psychology University of the Free State Bloemfontein South Africa
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