1
|
Agyeman-Yeboah J, Ricks EJ, Williams M, Jordan PJ. Experiences of patients living with HIV and AIDS on antiretroviral therapy in Accra, Ghana. Curationis 2024; 47:e1-e7. [PMID: 38708757 PMCID: PMC11079341 DOI: 10.4102/curationis.v47i1.2444] [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: 11/25/2022] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND The human immunodeficiency virus and acquired immunodeficiency syndrome (HIV and AIDS) pandemic has greatly affected Africa, particularly Ghana. The pandemic remains a public health concern, particularly in terms of accessing essential medication and improving quality of life for people living with the disease. OBJECTIVES This study aimed to explore and describe the experiences of persons diagnosed and living with HIV who are on antiretroviral therapy. METHOD A qualitative, exploratory, descriptive, and contextual design was used. The research population included persons diagnosed with HIV who were receiving antiretroviral therapy at three public hospitals in Ghana. Data saturation was achieved after conducting 15 semi-structured interviews. Creswell's six steps of data analysis were used to analyse the data, which resulted in the emergence of one main theme and six sub-themes. RESULTS The main theme identified by the researchers highlighted the participants' diverse experiences of being diagnosed and living with HIV. It was found that the study participants expressed shock, disbelief, surprise, and fear of death after being diagnosed with HIV. The participants also experienced stigmatisation, discrimination, and rejection. CONCLUSION There is a need for further research on the extent of discrimination and stigmatisation and the effect on optimal adherence to antiretroviral therapy. Continuous public education on HIV is required to limit the extent of discrimination and stigmatisation.Contribution: The study has highlighted the various emotions related to stigma and discrimination expressed by persons living with HIV (PLHIV). The findings will guide policy on eliminating discrimination and stigmatisation for people living with HIV.
Collapse
Affiliation(s)
- Joana Agyeman-Yeboah
- Department of Nursing, International Maritime Hospital, Tema, Ghana; and Department of Nursing, Knutsford University College, Accra.
| | | | | | | |
Collapse
|
2
|
Tarkang EE, Manu E, Aku FY, Anaman-Torgbor J, Khuzwayo N. Sociodemographic and health systems determinants of antiretroviral therapy adherence among human immunodeficiency virus-positive patients in the Volta Region of Ghana: A multi-centre study. SAGE Open Med 2024; 12:20503121241229056. [PMID: 38357401 PMCID: PMC10865934 DOI: 10.1177/20503121241229056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/09/2024] [Indexed: 02/16/2024] Open
Abstract
Objectives Optimal adherence to antiretroviral therapy is required for viral load suppression. This study investigated the sociodemographic (age, sex, marital status, level of education, monthly income, settlement type, distance to the antiretroviral therapy-providing site, ethnicity) and health system (antiretroviral therapy-providing site) determinants of antiretroviral therapy adherence among human immunodeficiency virus-positive patients in the Volta Region, Ghana. Methods A cross-section design was adopted, collecting data from 1729 human immunodeficiency virus patients and analysing them using STATA version 17 at level 0.05. Results Antiretroviral therapy adherence was poor (51.2%). Being divorced (Adjusted odds ratio (AOR) = 0.65), widow (AOR = 0.58), cohabiting (AOR = 0.22), Ewe (AOR = 3.7), Ga/Dangbe (AOR = 2.27), living in a rural area (AOR = 1.54) and an urban area (AOR = 0.64), having a monthly income of GH₵1000 or less (AOR = 3.21), covering a distance of 51 km and above to the antiretroviral therapy centre (AOR = 1.79), receiving antiretroviral therapy from Ketu South Municipal Hospital (AOR = 0.09), Hohoe Municipal Hospital (AOR = 0.03), Ho Municipal Hospital (AOR = 0.02) and Ho Teaching Hospital (AOR = 0.09) were the determinants of antiretroviral therapy adherence. Conclusion Antiretroviral therapy adherence was low. Interventions to improve antiretroviral therapy adherence should target these significant determinants.
Collapse
Affiliation(s)
- Elvis Enowbeyang Tarkang
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- HIV/AIDS Prevention Research Network Cameroon, Kumba, Cameroon
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Emmanuel Manu
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Fortress Yayra Aku
- Department of Epidemiology and Biostatistics, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
| | - Judith Anaman-Torgbor
- Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Hohoe, Ghana
| | - Nelisiwe Khuzwayo
- Department of Population and Behavioural Sciences, School of Public Health, University of Health and Allied Sciences, Hohoe, Ghana
- Department of Public Health Medicine, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
3
|
Aytenew TM, Demis S, Birhane BM, Asferie WN, Simegn A, Nibret G, Kassaw A, Asnakew S, Tesfahun Y, Andualem H, Bantie B, Kassaw G, Kefale D, Zeleke S. Non-Adherence to Anti-Retroviral Therapy Among Adult People Living with HIV in Ethiopia: Systematic Review and Meta-Analysis. AIDS Behav 2024; 28:609-624. [PMID: 38157133 PMCID: PMC10876791 DOI: 10.1007/s10461-023-04252-4] [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] [Accepted: 12/08/2023] [Indexed: 01/03/2024]
Abstract
Human immunodeficiency virus remains a global public health problem. Despite efforts to determine the prevalence of non-adherence to ART and its predictors in Ethiopia, various primary studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of non-adherence to ART and identify its predictors. We have searched PubMed, Google Scholar and Web of Science databases extensively for all available studies. A weighted inverse-variance random-effects model was used to compute the overall non-adherence to ART. The pooled prevalence of non-adherence to ART was 20.68% (95% CI: 17.74, 23.61); I2 = 98.40%; p < 0.001). Educational level of primary school and lower [AOR = 3.5, 95%CI: 1.7, 7.4], taking co-medications [AOR = 0.45, 95%CI: 0.35, 0.59], not using memory aids [AOR = 0.30, 95%CI: 0.13, 0.71], depression [AOR = 2.0, 95%CI: 1.05, 3.79], comorbidity [AOR = 2.12, 95%CI: 1.16, 3.09), under-nutrition [AOR = 2.02, 95%CI: 1.20, 3.43], not believing on ART can control HIV [AOR = 2.31, 95%CI: 1.92, 2.77], lack of access to health facilities [AOR = 3.86, 95%CI: 1.10, 13.51] and taking ART pills uncomfortably while others looking [AOR = 5.21, 95%CI: 2.56, 10.53] were significantly associated with non-adherence to anti-retroviral therapy. The overall pooled prevalence of non-adherence to ART was considerably high in Ethiopia. Educational status, taking co-medications, not using memory aids, depression, comorbidity, under nutrition, not believing on anti-retroviral therapy controls HIV, lack of access to health facilities and taking ART pills uncomfortably were independent predictors of non-adherence to ART in Ethiopia. Therefore, healthcare providers, adherence counselors and supporters should detect non-adherence behaviors and patients' difficulties with ART early, and provide intensive counseling to promote adherence.
Collapse
Affiliation(s)
- Tigabu Munye Aytenew
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Solomon Demis
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | | | - Worku Necho Asferie
- Department of Maternity and Neonatal Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Simegn
- Department of Reproductive Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gedefaye Nibret
- Department of Reproductive Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Amare Kassaw
- Department of Pediatrics and Child health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sintayehu Asnakew
- Department of Psychiatry, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Yohannes Tesfahun
- Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Henock Andualem
- Department of Medical Laboratory, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Berihun Bantie
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Gebrie Kassaw
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Demewoz Kefale
- Department of Pediatrics and Child health Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| | - Shegaw Zeleke
- Department of Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Boah M, Yeboah D, Kpordoxah MR, Issah AN, Adokiya MN. Temporal trend analysis of the HIV/AIDS burden before and after the implementation of antiretroviral therapy at the population level from 1990 to 2020 in Ghana. BMC Public Health 2023; 23:1399. [PMID: 37474958 PMCID: PMC10360237 DOI: 10.1186/s12889-023-16321-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 07/17/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Antiretroviral therapy (ART) has helped reduce the burden of human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) in the majority of countries. Its contribution to the HIV/AIDS burden in Ghana is still understudied. This study examined HIV/AIDS trends in Ghana before (1990-2004) and after (2004-2020) the implementation and expansion of ART. METHODS We obtained HIV/AIDS epidemiology and treatment data for the years 1990-2020 from the United Nations Programme on HIV/AIDS. We investigated the impact of the ART rollout on HIV/AIDS in Ghana using Joinpoint regression models. RESULTS The HIV incidence, prevalence, and AIDS-related deaths decreased significantly after 2004, as ART coverage increased from 1% to 2004 to 60% in 2020. The HIV incidence decreased by approximately 3% (AAPC = -2.6%; 95% CI: -3.2, -1.9) per year from 1990 to 2004 and approximately 5% (AAPC = -4.5%; 95% CI: -4.9, -4.2) per year from 2004 to 2020. Between 1990 and 2004, the HIV prevalence increased by approximately 5% (AAPC = 4.7%; 95% CI: 3.6, 5.8) per year but decreased by 2% (AAPC = -1.9%; 95% CI: -2.1, -1.6) per year between 2004 and 2020. Between 1990 and 2004, the annual increase in AIDS-related mortality was 14% (AAPC = 13.8%; 95% CI: 12.6, 15.0), but between 2004 and 2020, it decreased at nearly a 4% (AAPC= -3.6%; 95% CI: -4.7, -2.5) annual rate. CONCLUSIONS We found trends indicating progress in Ghana's fight against HIV/AIDS. However, the most significant declines occurred after the introduction of ART, suggesting that the scale-up of ART may have contributed to the decline in HIV/AIDS in Ghana. We advocate for the rapid expansion of ART in Ghana.
Collapse
Affiliation(s)
- Michael Boah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana.
| | - Daudi Yeboah
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Mary Rachael Kpordoxah
- Department of Global and International Health, School of Public Health, University for Development Studies, Tamale, Ghana
| | - Abdul-Nasir Issah
- Department of Health Services, Planning, Management, and Economics, School of Public Health, University for Development Studies, Policy, Tamale, Ghana
| | - Martin Nyaaba Adokiya
- Department of Epidemiology, Biostatistics, and Disease Control, School of Public Health, University for Development Studies, Tamale, Ghana
| |
Collapse
|
6
|
Tuot S, Sim JW, Nagashima-Hayashi M, Chhoun P, Teo AKJ, Prem K, Yi S. What are the determinants of antiretroviral therapy adherence among stable people living with HIV? A cross-sectional study in Cambodia. AIDS Res Ther 2023; 20:47. [PMID: 37452342 PMCID: PMC10347818 DOI: 10.1186/s12981-023-00544-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND Understanding context-specific determinants of antiretroviral therapy (ART) adherence is crucial for developing tailored interventions for improving health outcomes and achieving the UNAIDS' third 95% target. This cross-sectional study explores factors associated with ART adherence among stable people living with HIV on ART in Cambodia. METHODS We used baseline survey data from a quasi-experimental study conducted in 2021. The participants were recruited from 20 ART clinics in nine provinces for face-to-face interviews. A structured questionnaire collected information on sociodemographic characteristics, ART adherence, perceived ART self-efficacy, mental health, quality of life, stigma, and discrimination. We conducted bivariate and multiple logistic regression analyses to identify factors associated with ART adherence. RESULTS Out of the 4101 participants, 86.5% reported adhering to ART in the past two months. The adjusted odds of ART adherence were significantly higher among participants in older age groups than those aged 15-29, participants with elevated cholesterol than those without it, participants who exhibited strong self-efficacy in health responsibility to maintain life than those with poor self-efficacy in health responsibility, participants who scored < 3 on the stigma and discrimination scale than those who scored ≥ 3, participants who scored ≥ 42 on the mental component of the quality-of-life scale than those who scored < 42. The adjusted odds of ART adherence were significantly lower in participants who earned > 301 USD per month than those who earned ≤ 100 USD per month. CONCLUSION The ART adherence rate among stable people living with HIV in this study was comparable to that of the general people living with HIV in Cambodia. The results suggest the need for innovative interventions to further reduce stigma and discrimination and strategies to improve the self-efficacy and mental health of people living with HIV to improve ART adherence.
Collapse
Affiliation(s)
- Sovannary Tuot
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
- Department of Community and Global Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
- Faculty of Social Sciences and Humanity, Royal University of Phnom Penh, Phnom Penh, Cambodia
| | - Jian Wei Sim
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10- 01, 117549, Singapore, Singapore
| | - Michiko Nagashima-Hayashi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10- 01, 117549, Singapore, Singapore
| | - Pheak Chhoun
- KHANA Center for Population Health Research, Phnom Penh, Cambodia
| | - Alvin Kuo Jing Teo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10- 01, 117549, Singapore, Singapore
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Kiesha Prem
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10- 01, 117549, Singapore, Singapore
- Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK
| | - Siyan Yi
- KHANA Center for Population Health Research, Phnom Penh, Cambodia.
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, 12 Science Drive 2, #10- 01, 117549, Singapore, Singapore.
- Center for Global Health Research, Public Health Program, Touro University California, Vallejo, CA, USA.
| |
Collapse
|
7
|
Nutor JJ, Gyamerah AO, Alhassan RK, Duah HO, Thompson RGA, Wilson N, Harris O, Gutierrez J, Hoffmann TJ, Getahun M, Santos GM. Influence of depression and interpersonal support on adherence to antiretroviral therapy among people living with HIV. AIDS Res Ther 2023; 20:42. [PMID: 37386514 PMCID: PMC10308781 DOI: 10.1186/s12981-023-00538-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 06/20/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Poor adherence and under-utilization of antiretroviral therapy (ART) services have been major setbacks to achieving 95-95-95 policy goals in Sub-Saharan Africa. Social support and mental health challenges may serve as barriers to accessing and adhering to ART but are under-studied in low-income countries. The purpose of this study was to examine the association of interpersonal support and depression scores with adherence to ART among persons living with HIV (PLWH) in the Volta region of Ghana. METHODS We conducted a cross-sectional survey among 181 PLWH 18 years or older who receive care at an ART clinic between November 2021 and March 2022. The questionnaire included a 6-item simplified ART adherence scale, the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), and the 12-item Interpersonal Support Evaluation List-12 (ISEL-12). We first used a chi-squared or Fisher's exact test to assess the association between these and additional demographic variables with ART adherence status. We then built a stepwise multivariable logistic regression model to explain ART adherence. RESULTS ART adherence was 34%. The threshold for depression was met by 23% of participants, but it was not significantly associated with adherence in multivariate analysis(p = 0.25). High social support was reported by 48.1%, and associated with adherence (p = 0.033, aOR = 3.45, 95% CI = 1.09-5.88). Other factors associated with adherence included in the multivariable model included not disclosing HIV status (p = 0.044, aOR = 2.17, 95% CI = 1.03-4.54) and not living in an urban area (p = 0.00037, aOR = 0.24, 95% CI = 0.11-0.52). CONCLUSION Interpersonal support, rural residence, and not disclosing HIV status were independent predictors of adherence to ART in the study area.
Collapse
Affiliation(s)
- Jerry John Nutor
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA.
| | - Akua O Gyamerah
- Department of Community Health and Health Behavior, University of Buffalo, Buffalo, NY, USA
| | - Robert Kaba Alhassan
- Centre for Health Policy and Implementation Research, Institute of Health Research, University of Health and Allied Sciences, Ho, Ghana
| | - Henry Ofori Duah
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Rachel G A Thompson
- Language Center, College of Humanities, University of Ghana, Accra, Ghana
- Africa Interdisciplinary Research Institute, Accra, Ghana
| | - Natalie Wilson
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Orlando Harris
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Jose Gutierrez
- Department of Family Health Care Nursing, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| | - Thomas J Hoffmann
- Department of Epidemiology and Biostatistics, Office of Research, School of Nursing, University of California, San Francisco, San Francisco, CA, USA
| | - Monica Getahun
- Institute for Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Glenn-Milo Santos
- Department of Community Health Systems, School of Nursing, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
8
|
Eze RA, Sulaiman N, Mat Daud Z'A, Babadoko A. Association Between Belief in Medicine and Adherence to Antiretroviral Therapy Among Human Immunodeficiency Virus Adults in Zaira, Kaduna State, Nigeria. Cureus 2023; 15:e36489. [PMID: 37090307 PMCID: PMC10118400 DOI: 10.7759/cureus.36489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2023] [Indexed: 04/25/2023] Open
Abstract
BACKGROUND Negative perceptions of antiretroviral treatment (ART)'s efficacy and consequences may operate as roadblocks to adherence. This research aimed to determine the association between belief in medicine and adherence to antiretroviral therapy among HIV adults on ART in Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria. METHOD Using a cross-sectional design, a systematic random sampling method was used to select respondents aged 18-64 years on antiretroviral therapy for at least six months at Ahmadu Bello University Teaching Hospital, outpatients of the President's Emergency Plan for AIDS Relief Clinic. Socio-demographics, belief in medicine and adherence to ART were obtained using a self-administered questionnaire. Descriptive statistics, chi-square test, and multiple logistic regression were used for data analysis. RESULTS Among the 385 people who took part in the study, about 67.5% were females and 32.5% were males. About 54% of adults adhered to ART. More than half (55.8%) of the respondents had negative perceptions (beliefs) of personal need for ART medication and about 42.3% of the respondents had more concerns about the potential negative effects of the ART medication. Government employment (odds ratio (OR) = 2.842, p = <0.01), self-employment (OR = 2.6, p = <0.001), and being divorced or widowed (OR = 2.0, p = <0.01), negative perceptions (beliefs) of personal need for the ART medication (adjusted OR (AOR) = 1.525, p=<0.01) and more concerns about the potential negative effects of the ART medication (AOR= 1.362, p = <0.05) were all significantly associated with ART adherence. CONCLUSION Employment, marital status and belief in medicine were associated with adherence to ART. Therefore, during adherence counseling, healthcare personnel should address respondents' false views and fears regarding ART medication in order to strengthen proper information and the benefits of ART. This article was previously presented as a meeting poster at the 36th Scientific Conference of the Nutrition Society of Malaysia (7th and 8th September 2021).
Collapse
Affiliation(s)
- Rosemary A Eze
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Norhasmah Sulaiman
- Department of Nutrition, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Zulfitri 'Azuan Mat Daud
- Department of Dietetics, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Aliyu Babadoko
- Department of Haematology, Ahmadu Bello University Teaching Hospital, Zaria, NGA
| |
Collapse
|
9
|
Ali Abdulai M, E.F Mevissen F, Kramer A, Boitelet Z, Poku Asante K, Owusu-Agyei S, Ruiter RA, E.R Bos A. A qualitative analysis of factors influencing healthcare providers’ behaviour toward persons living with HIV in Ghana. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2023. [DOI: 10.1016/j.ijans.2023.100532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
|
10
|
Adu C, Mensah KA, Ahinkorah BO, Osei D, Tetteh AW, Seidu AA. Socio-demographic factors associated with medication adherence among People Living with HIV in the Kumasi Metropolis, Ghana. AIDS Res Ther 2022; 19:50. [PMCID: PMC9662109 DOI: 10.1186/s12981-022-00474-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 10/07/2022] [Indexed: 11/16/2022] Open
Abstract
Abstract
Background
Medication adherence is important to the survival of People Living with HIV (PLHIV) globally. Although, HIV viral load is reduced by antiretroviral therapy (ART), the number of people on ART continues to rise in Ghana. In the Kumasi Metropolis, Ghana, we looked at the socio-demographic factors associated with medication adherence among PLHIV.
Methods
A quantitative study involving 420 PLHIV who sought healthcare at the Kumasi South Regional Hospital was conducted utilizing a cross-sectional study design. We employed a structured questionnaire to collect data on medication adherence using the eight-item Morisky Medication Adherence Scale (MMAS) and socio-demographic factors that influence medication adherence. The data were analysed using Stata 14.2. Frequencies and percentages were used to present the descriptive data. The association between socio-demographic factors and medication adherence among PLHIV was investigated using both univariate and multivariate analyses.
Results
More than half (53.10%) of PLHIV adhered to ART. Place of residence was significantly established to be influencing medication adherence among PLHIV. PLHIV who were residing in urban centers (aOR = 3.61; CI = 2.24–5.82) were more likely to adhere to medication as compared to those who resided in rural areas.
Conclusion
Slightly more than half of PLHIV took their medicines as prescribed. Government and Policymakers such as the Ghana AIDS Commission, Ministry of Health, and Ghana Health Service should incorporate socio-demographic factors such as place of residence while creating and executing medication adherence initiatives to evaluate HIV management regimen for PLHIV.
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Agyeman-Yeboah J, Ricks EJ, Williams M, Jordan PJ, Ten Ham-Baloyi W. Integrative literature review of evidence-based guidelines on antiretroviral therapy adherence among adult persons living with HIV. J Adv Nurs 2022; 78:1909-1918. [PMID: 35405023 DOI: 10.1111/jan.15245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 01/25/2022] [Accepted: 03/23/2022] [Indexed: 11/28/2022]
Abstract
AIM To summarize recommendations from available evidence-based guidelines that enhance, address or guide antiretroviral therapy adherence among adult persons living with human immunodeficiency virus. DESIGN An integrative literature review approach. DATA SOURCE Guidelines were accessed through Google from the databases of the Canadian Medical Association InfoBase clinical practice database, National Guidelines Clearinghouse, Writer's Guidelines database, the National Institute for Health and Clinical Excellence, UNICEF and WHO. Databases such as PubMed, Google Scholar, EBSCOhost (CINAHL, ERIC, Academic search complete, E-journals, Psych Info and MEDLINE), EMERALD INSIGHT, JSTOR, SCIENCE DIRECT and FINDPLUS were also searched, followed by a citation search. Data sources were searched between 1996 and January 2022. REVIEW METHODS The five steps of the integrative literature review process, as described by Whittemore and Knafl, were used. These steps are as follows: step one; problem identification, step two; literature search, step three; data evaluation; step four: data analysis and the final step was data presentation. RESULTS Sixteen guidelines related to antiretroviral therapy adherence were included for data extraction and synthesis. The findings revealed two themes as follows: theme 1: monitoring antiretroviral therapy adherence and theme 2: interventions to promote antiretroviral therapy adherence related to education and counselling, adherence tools, health service delivery and antiretroviral strategies. CONCLUSION Antiretroviral therapy adherence in adult persons requires both interventions as well as monitoring. The various contributing factors relating to antiretroviral therapy adherence should be further explored. IMPACT Evidence from the included guidelines can assist nurses in promoting a person's adherence to antiretroviral treatment, which could improve their health and well-being.
Collapse
Affiliation(s)
- Joana Agyeman-Yeboah
- Department of Nursing, International Maritime Hospital, Tema, Ghana.,Knutsford University College, Accra, Ghana
| | | | - Margaret Williams
- Department of Nursing Science, Nelson Mandela University, Gqeberha, South Africa
| | - Portia Janine Jordan
- Department of Nursing and Midwifery, Stellenbosch University, Stellenbosch, South Africa
| | | |
Collapse
|
13
|
Exavery A, Charles J, Kuhlik E, Barankena A, Abdul R, Mubyazi GM, Kyaruzi C, Kikoyo L, Jere E, Balampama M. Hunger and Adherence to Antiretroviral Therapy: Learning From HIV Positive Caregivers of Orphans and Vulnerable Children in Tanzania. Front Public Health 2022; 9:719485. [PMID: 35265581 PMCID: PMC8898952 DOI: 10.3389/fpubh.2021.719485] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 12/30/2021] [Indexed: 11/23/2022] Open
Abstract
The association between hunger and adherence to antiretroviral therapy (ART) is less known especially in vulnerable populations receiving HIV care and treatment services. Caregivers of orphans and vulnerable children (OVC) are vulnerable and likely to experience hunger due to additional economic pressure in caring for OVC. Using data from the community–based, USAID–funded Kizazi Kipya project, this study assesses the association between hunger and ART adherence among caregivers of OVC in Tanzania. HIV positive caregivers enrolled in the project from January to July 2017 were analyzed. The outcome variable was adherence to ART, defined as “not having missed any ART dose in the last 30 days,” and household hunger, measured using the Household Hunger Scale (HHS), was the main independent variable. Data analysis included multivariable logistic regression. The study analyzed 11,713 HIV positive caregivers who were on ART at the time of enrollment in the USAID Kizazi Kipya project in 2017. Aged 48.2 years on average, 72.9% of the caregivers were female. While 34.6% were in households with little to no hunger, 59.4 and 6.0% were in moderate hunger and severe hunger households, respectively. Overall, 90.0% of the caregivers did not miss any ART dose in the last 30 days. ART adherence rates declined as household hunger increased (p < 0.001). Multivariable analysis showed that the odds of adhering to ART was significantly lower by 42% among caregivers in moderate hunger households than those in little to no hunger households (OR = 0.58, 95% CI 0.50–0.68). The decline increased to 47% among those in severe hunger households (OR = 0.53, 95% CI 0.41–0.69). Hunger is an independent and a significant barrier to ART adherence among caregivers LHIV in Tanzania. Improving access to adequate food as part of HIV care and treatment services is likely to improve ART adherence in this population.
Collapse
Affiliation(s)
| | | | | | | | - Ramadhani Abdul
- Impact Evaluation, Ifakara Health Institute, Dar es Salaam, Tanzania
| | - Godfrey M Mubyazi
- Health Systems and Policy Research, National Institute for Medical Research, Dar es Salaam, Tanzania
| | | | | | | | | |
Collapse
|
14
|
Sefah IA, Mensah F, Kurdi A, Godman B. Barriers and facilitators of adherence to antiretroviral treatment at a public health facility in Ghana: a mixed method study. Hosp Pract (1995) 2022; 50:110-117. [PMID: 35189065 DOI: 10.1080/21548331.2022.2045132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND HIV/AIDS is a disease of global public health concern with high morbidity and mortality rates. Poor adherence to antiretroviral therapy (ART) increases the risk of viral drug resistance and reduces treatment effectiveness towards viral suppression leading to disease progression, greater risk of death and increased risk of viral transmission. The study sought to assess current adherence levels to ART among patients in Ghana, exploring barriers and enablers of adherence to it, to provide future guidance to all key stakeholder groups. METHOD A mixed method approach was used comprising of a cross-sectional survey of patients followed by a focused group discussion with patients and an in-depth interview of four key health professionals working in the ART clinic of Atua Government Hospital, a primary care health facility in the Eastern Region of Ghana. A structured questionnaire was used to assess current adherence levels and their determinants among 231 randomly selected patients attending the clinic between July to September, 2019. Quantitative data were analysed using bivariate and multivariate methods while qualitative data were analysed using thematic framework approach. RESULTS Adherence levels was found to be 42.9% among our study population. Lower adherence to ART was associated with patients' belief in herbal medicine (aOR =0.34 CI: 0.19-0.61). Other barriers identified from the qualitative analysis included low motivation arising from pill fatigue, forgetfulness, frequent stock out of medicines, long waiting times and worrying side-effects; while enablers, on the other hand, included measures that ensure improved assessment of adherence and health facility-related activities that improve patient satisfaction with ART services. Conclusion: Adherence to ART among patients living with HIV was sub-optimal in our study population. Understanding of the barriers and factors that enable adherence to ART is a key step to developing evidence-based adherence improvement strategies to enhance clinical outcomes.
Collapse
Affiliation(s)
- Israel Abebrese Sefah
- Pharmacy Practice Department, School of Pharmacy, University of Health and Allied Sciences, Volta Region, Ghana
| | - Frederick Mensah
- Pharmacy Department, Atua Government Hospital, Eastern Region, Ghana
| | - Amanj Kurdi
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq.,Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, United Kingdom.,School of Pharmacy, Sefako Makgatho Health Sciences University, Ga-Rankuwa, Pretoria, 0208, South Africa.,Centre of Medical and Bio-allied Health Sciences Research, Ajman University, United Arab Emirates
| |
Collapse
|
15
|
Abdulai MA, Marable JK, Wadus A, Asante KP. A qualitative analysis of factors influencing health-seeking behavior of people living with HIV, hypertension and diabetes in an urban area of Ghana. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221092664. [PMID: 35586035 PMCID: PMC9106310 DOI: 10.1177/26335565221092664] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Non-communicable diseases are rising globally and lower-middle-income countries are now facing a double-burden of communicable and non-communicable diseases like hypertension and diabetes. Patients with HIV/AIDS are at increased risk of developing hypertension and diabetes. Understanding how this double-burden influences persons living with HIV health-seeking behavior (HSB) is critical to identifying successful interventions and policies. To explore the factors that influence the health-seeking behavior of HIV patients with hypertension and diabetes in an urban setting of Ghana, we undertook a qualitative study consisting of sixteen in-depth interviews (five healthcare providers [HCP] and eleven patients); all recruited from Antiretroviral Therapy (ART) clinics in the Techiman South Municipality of Ghana. Interview questions were designed to explore cognitive, affective, social, and environmental factors that influence an individual’s decision-making process and behavior. All interviews were audio-recorded, transcribed, and analyzed thematically. Participants raised unique challenges while seeking treatment services for HIV, hypertension, and diabetes. Frequent appointments, increased pill burden, food restrictions, alternate sources of care (herbalist and pastors), and negative psychological wellbeing were some of the challenges noted for seeking treatment services. Challenges with the health facility, including separate clinic days for comorbid conditions, high costs of medications and transportation, and long waiting hours were also cited as influencing health-seeking behavior. Results indicate greater challenges for HIV patients living with hypertension and diabetes in accessing treatment services. Understanding this is critical to removing barriers and making treatment more accessible. Further integration of treatment for hypertension and diabetes into HIV care is essential to ensuring patient engagement in continuous care.
Collapse
Affiliation(s)
- Martha Ali Abdulai
- Kintampo Health Research Centre, Research and Development Division, Ghana
| | - Julian K Marable
- Department of Global Health, Georgetown University, Washington, DC, USA
| | - Awudu Wadus
- Kintampo Health Research Centre, Research and Development Division, Ghana
| | - Kwaku Poku Asante
- Kintampo Health Research Centre, Research and Development Division, Ghana
| |
Collapse
|
16
|
Chenneville T, Gabbidon K, Hornschuh S, Dietrich J. Balancing Autonomy and Protection in Pediatric Treatment and Research. Adv Pediatr 2021; 68:55-69. [PMID: 34243859 DOI: 10.1016/j.yapd.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Tiffany Chenneville
- Department of Psychology, University of South Florida, 140 7th Avenue South, DAV 117, St. Petersburg, FL 33701, USA.
| | - Kemesha Gabbidon
- Department of Psychology, University of South Florida, 140 7th Avenue South, DAV 117, St. Petersburg, FL 33701, USA
| | - Stefanie Hornschuh
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, New Nurses Home, Diepkloof, Soweto 1864, Johannesburg, Gauteng, South Africa
| | - Janan Dietrich
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of Witwatersrand, New Nurses Home, Diepkloof, Soweto 1864, Johannesburg, Gauteng, South Africa; Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| |
Collapse
|
17
|
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
| |
Collapse
|
18
|
Abadiga M, Hasen T, Mosisa G, Abdisa E. Adherence to antiretroviral therapy and associated factors among Human immunodeficiency virus positive patients accessing treatment at Nekemte referral hospital, west Ethiopia, 2019. PLoS One 2020; 15:e0232703. [PMID: 32392244 PMCID: PMC7213685 DOI: 10.1371/journal.pone.0232703] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 04/20/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Antiretroviral therapy has a remarkable clinical effect in reducing the progress of Acquired Immune Deficiency Syndrome. The clinical outcome of Anti-Retroviral therapy depends on strict adherence. Poor adherence reduces the effectiveness of antiretroviral therapy and increases viral replication. With changes in service delivery over time and differences in socio-demographic status from region to region, it is essential to measure adherence. Therefore, this study aimed to assess adherence to antiretroviral therapy and its associated factors among HIV/AIDS patients accessing treatment at Nekemte referral hospital, West Ethiopia. METHODS Institutional based cross-sectional study was conducted on 311 HIV/AIDS patients from March 01 to March 30, 2019. The study participants were selected by a simple random sampling method and interviewed using structured questionnaires. Bivariable logistic regression was conducted to find an association between each independent variable and adherence to antiretroviral medication. Multivariable logistic regression was used to find the independent variables which best predict adherence. The statistical significance was measured using odds ratio at a 95% confidence interval with a p-value of less than 0.05. RESULTS Out of a total of 311 patients sampled, 305 were participated in the study, making a response rate of 98.07%. From these 305 study participants,73.1% (95% CI = 68.2, 78.0) were adherent to their medication. Having knowledge about HIV and its treatment (AOR = 8.24, 95% CI: 3.10, 21.92), having strong family/social support (AOR = 6.21, 95% CI: 1.39, 27.62), absence of adverse drug reaction (AOR = 5.33, 95% CI: 1.95, 14.57), absence of comorbidity of other chronic diseases (AOR = 5.72, 95% CI: 1.91, 17.16) and disclosing HIV status to the family (AOR = 5.08, 95% CI: 2.09, 12.34) were significantly associated with an increased likelihood of adherence to antiretroviral medication. CONCLUSION The level of adherence to antiretroviral therapy was found low compared to WHO recommendation. The clinician should emphasize reducing adverse drug reaction, detecting and treating co-morbidities early, improving knowledge through health education, and encouraging the patients to disclose their HIV status to their families.
Collapse
Affiliation(s)
- Muktar Abadiga
- School of Nursing and midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tahir Hasen
- School of Nursing and midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Getu Mosisa
- School of Nursing and midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Eba Abdisa
- School of Nursing and midwifery, Institute of Health Sciences, Wollega University, Nekemte, Ethiopia
| |
Collapse
|
19
|
Dzansi G, Tornu E, Chipps J. Promoters and inhibitors of treatment adherence among HIV/AIDS patients receiving antiretroviral therapy in Ghana: Narratives from an underserved population. PLoS One 2020; 15:e0230159. [PMID: 32142549 PMCID: PMC7059913 DOI: 10.1371/journal.pone.0230159] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/22/2020] [Indexed: 11/19/2022] Open
Abstract
Adherence to antiretroviral therapy (ART) is essential to achieving an improved cluster of differentiation-4 (CD4) count, viral load, and quality of life while preventing drug resistance. Medication adherence among people living with Human Immunodeficiency Virus (HIV) is influenced by different factors. Several studies have identified adherence promoters and inhibitors that emanate from the internal and external environment. We conducted six (6) individual in-depth interviews and three (3) focus group discussions to explore adherence behaviour among patients diagnosed with HIV in a teaching hospital in Accra, Ghana. Participants were drawn from the intervention arm of a mobile phone adherence intervention program. They had been enrolled in the study for at least six (6) months before the interviews are conducted. Results revealed that participants adhered to treatment irrespective of prompts from significant others. Adherence promoters included perception of ART as part of daily routines, benefits of the ART, awareness of regimen, access to food, and transparency. Adherence inhibitors were forgetfulness, secrecy, waiting time, religious beliefs, and sleep. People living with HIV (PLWHIV) have the personal motivation to take medication; however, negative perceptions about HIV must be addressed to ensure optimum adherence behaviour.
Collapse
Affiliation(s)
- Gladys Dzansi
- Department of Adult Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
| | - Eric Tornu
- Department of Adult Health, School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
- * E-mail:
| | - Jeniffer Chipps
- School of Nursing and Midwifery, University of the Western Cape, Cape Town, South Africa
| |
Collapse
|
20
|
Ekong E, Ndembi N, Okonkwo P, Dakum P, Idoko J, Banigbe B, Okuma J, Agaba P, Blattner W, Adebamowo C, Charurat M. Epidemiologic and viral predictors of antiretroviral drug resistance among persons living with HIV in a large treatment program in Nigeria. AIDS Res Ther 2020; 17:7. [PMID: 32066473 PMCID: PMC7027291 DOI: 10.1186/s12981-020-0261-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 01/23/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Expanded access to combination antiretroviral therapy (cART) throughout sub-Saharan Africa over the last decade has remarkably improved the prognosis of persons living with HIV (PLWH). However, some PLWH experience virologic rebound after a period of viral suppression, usually followed by selection of drug resistant virus. Determining factors associated with drug resistance can inform patient management and healthcare policies, particularly in resource-limited settings where drug resistance testing is not routine. METHODS A case-control study was conducted using data captured from an electronic medical record in a large treatment program in Nigeria. Cases PLWH receiving cART who developed acquired drug resistance (ADR) and controls were those without ADR between 2004 and 2011. Each case was matched to up to 2 controls by sex, age, and education. Logistic regression was used estimate odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with ADR. RESULTS We evaluated 159 cases with ADR and 299 controls without ADR. In a multivariate model, factors associated with ADR included older age (OR = 2.35 [age 30-40 years 95% CI 1.29, 4.27], age 41 + years OR = 2.31 [95% CI 1.11, 4.84], compared to age 17-30), higher education level (secondary OR 2.14 [95% CI 1.1.11-4.13]), compared to primary and tertiary), non-adherence to care (OR = 2.48 [95% CI 1.50-4.00]), longer treatment duration (OR = 1.80 [95% CI 1.37-2.35]), lower CD4 count((OR = 0.95 [95% CI 0.95-0.97]) and higher viral load (OR = 1.97 [95% CI 1.44-2.54]). CONCLUSIONS Understanding these predictors may guide programs in developing interventions to identify patients at risk of developing ADR and implementing prevention strategies.
Collapse
Affiliation(s)
- Ernest Ekong
- Department of Prevention, Care and Treatment, Institute of Human Virology-Nigeria (IHVN), Federal Capital Territory, Plot 252, Herbert Macaulay Way, Central Business District, Abuja, Nigeria.
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Nicaise Ndembi
- Department of Prevention, Care and Treatment, Institute of Human Virology-Nigeria (IHVN), Federal Capital Territory, Plot 252, Herbert Macaulay Way, Central Business District, Abuja, Nigeria.
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | | | - Patrick Dakum
- Department of Prevention, Care and Treatment, Institute of Human Virology-Nigeria (IHVN), Federal Capital Territory, Plot 252, Herbert Macaulay Way, Central Business District, Abuja, Nigeria
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - John Idoko
- Jos University Teaching Hospital, Jos, Nigeria
| | | | - James Okuma
- Department of Prevention, Care and Treatment, Institute of Human Virology-Nigeria (IHVN), Federal Capital Territory, Plot 252, Herbert Macaulay Way, Central Business District, Abuja, Nigeria
| | | | - William Blattner
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Clement Adebamowo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Manhattan Charurat
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD, USA
| |
Collapse
|
21
|
Legesse TA, Reta MA. Adherence to Antiretroviral Therapy and Associated Factors among People Living with HIV/AIDS in Hara Town and Its Surroundings, North-Eastern Ethiopia: A Cross-Sectional Study. Ethiop J Health Sci 2020; 29:299-308. [PMID: 31447498 PMCID: PMC6689727 DOI: 10.4314/ejhs.v29i3.2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Background Adherence is the most important factor in determining Antiretroviral Therapy (ART) treatment success and long-term viral suppression. Nonadherence to ART led to the human Immunodeficiency Virus (HIV) related morbidity and mortality. Moreover, it intensifies the risk of the emerging drug resistant HIV strains. This study aimed to assess the level of ART adherence and to identify its predictive associated factors among people living with HIV/AIDS in Hara Town and its surroundings, North-Eastern Ethiopia. Methods An institutional facility based cross-sectional study was conducted from April-May 2017. A total of 454 individuals were on ART follow-up in the selected ART-clinic, and only 418 patients were recruited. Bivariate and multivariate logistic regression analyses were carried out to identify associated factors. Odds ratio and 95% Confidence Interval (CI) were calculated to determine the level of significance. Results The level of ART adherence in the study setting was 300 (71.8%). Participants who had not disclosed their HIV status to their families were 88% less likely to adhere to their ART medication than those who had disclosed their HIV status ((Odds ratio (OR): 0.12, 95%CI:0.05–0.58; p<0.001). On the other hand, participants who had not encountered drug side effects were 2.69 times more likely to adhere to their ART medication than those who had ever encountered drug side effects (OR: 2.69, 95%CI:1.27–5.05; p<0.001). Conclusion A very low level of ART adherence was shown in the study population. It was below the recommended good adherence standard. Therefore, patients should get adequate and comprehensive ART adherence counselling before initiation ART treatment and during the follow-up time.
Collapse
Affiliation(s)
- Tesfaye Aychew Legesse
- Department of Nursing, Faculty of Health Sciences, Woldia University; P.O. Box 400; Woldia, Ethiopia
| | - Melese Abate Reta
- Department of Medical Laboratory Science, Faculty of Health Sciences, Woldia University; P.O. Box 400; Woldia, Ethiopia
| |
Collapse
|
22
|
Zhong H, Arjmand IK, Brandeau ML, Bendavid E. Health outcomes and cost-effectiveness of treating depression in people with HIV in Sub-Saharan Africa: a model-based analysis. AIDS Care 2020; 33:441-447. [PMID: 31986900 DOI: 10.1080/09540121.2020.1719966] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
High prevalence of depression among people living with HIV (PLHIV) impedes antiretroviral therapy (ART) adherence and viral suppression. We estimate the effectiveness and cost-effectiveness of strategies to treat depression among PLHIV in Sub-Saharan Africa (SSA). We developed a microsimulation model of HIV disease and care in Uganda which captured individuals' depression status and the relationship between depression and HIV behaviors. We consider a strategy of screening for depression and providing antidepressant therapy with fluoxetine at ART initiation or re-initiation (if a patient has dropped out). We estimate that over 10 years this strategy would reduce prevalence of depression among PLHIV by 16.0% [95% uncertainty bounds 15.8%, 16.1%] from a baseline prevalence of 28%, increase adherence to ART by 1.0% [1.0%, 1.0%], and decrease rates of loss to followup by 3.7% [3.4%, 4.1%]. This would decrease first-line ART failure rates by 2.5% [2.3%, 2.8%] and increase viral suppression rates by 1.0% [1.0%, 1.0%]. This strategy costs $15/QALY compared to the status quo, and was highly cost-effective over a broad range of sensitivity analyses. We conclude that screening for and treating depression among PLHIV in SSA with fluoxetine would be effective in improving HIV treatment outcomes and would be highly cost-effective.
Collapse
Affiliation(s)
- Huaiyang Zhong
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Isabel K Arjmand
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Margaret L Brandeau
- Department of Management Science and Engineering, Stanford University, Stanford, CA, USA
| | - Eran Bendavid
- Division of General Medical Disciplines, Department of Medicine, Stanford University, Stanford, CA, USA.,Center for Health Policy and the Center for Primary Care and Outcomes Research, Stanford University, Stanford, CA, USA
| |
Collapse
|
23
|
Chime OH, Ndibuagu EO, Orji CJ. Rates and predictors of adherence and retention for antiretroviral therapy among HIV-positive adults in Enugu, Nigeria. Malawi Med J 2019; 31:202-211. [PMID: 31839890 PMCID: PMC6895390 DOI: 10.4314/mmj.v31i3.7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 11/04/2018] [Accepted: 12/09/2018] [Indexed: 11/20/2022] Open
Abstract
Background HIV infection and AIDS are majorpublic health challenges in Nigeria, a country with one of the highest rates of new infection in sub-Saharan Africa and the second largest HIV epidemic in the world.Non-adherence to medication and defaulting from treatment are the two major challenges faced by anti-retroviral therapy (ART) programs in resource-constrained settings. This study was undertaken to determine the rate and predictors of adherence to medication and retention among people living with HIVin Enugu State, Nigeria. Methods This was a cross-sectionalretrospective study conducted among adults living with HIV(PLHIV) receiving ARTs in eightcomprehensive health facilities in Enugu, Nigeria. We used self-reported adherence and recorded clinic visits to assess adherence and retention, respectively. Descriptive statistics (frequencies, proportions, mean and standard deviation) and regression analysis were then conducted to identify the association between adherence, retention and demographic and health-related factors. Results The mean age of respondents was 38.5±9.8 years. Predictors of good adherence to medication includedbeing male(adjusted odds ratio [AOR]:2.08; 95% confidence interval [CI]:1.12-3.85), having been on anti-retroviral medications for more than 5 years (AOR:1.92; 95% CI: 1.17-3.16), the non-consumption of alcohol(AOR: 3.67; 95% CI: 2.01-6.70), not usingtraditional medicine (AOR: 2.76; 95% CI:1.33-5.73) and having a baseline CD4count exceeding 500 cells/µl (AOR: 5.67; 95% CI: 1.32-24.32).Adequate retention was predicted by being resident in the urban area (AOR: 1.90; 95% CI: 1.17-3.06). Being away from home (41.8%) and forgetfulness (35.0%) were reported as the major reasons for missing medication. Conclusion The rates of adherence and retention found in this study were similar to those reported forother resource-limited settings. Health education and behavioural modification interventions should be intensified to reduce the consumption of alcohol and the use of traditional medicine by people living with HIV. Identifying other factors may help to design effective strategies to ensure that people living with HIV adhere to their medications and remain in care.
Collapse
Affiliation(s)
- Onyinye Hope Chime
- Department of Community Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
- Department of Community Medicine, Enugu State University College of Medicine, Enugu, Nigeria
| | - Edmund Onyemaechi Ndibuagu
- Department of Community Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
- Department of Community Medicine, Enugu State University College of Medicine, Enugu, Nigeria
| | - Chinonyelu Jennie Orji
- Department of Community Medicine, Enugu State University Teaching Hospital, Enugu, Nigeria
| |
Collapse
|
24
|
Frempong MT, Ntiamoah P, Annani-Akollor ME, Owiredu WKBA, Addai-Mensah O, Owiredu EW, Adu-Gyasi D, Agyapong EO, Sallah L. Hepatitis B and C infections in HIV-1 and non-HIV infected pregnant women in the Brong-Ahafo Region, Ghana. PLoS One 2019; 14:e0219922. [PMID: 31323077 PMCID: PMC6641208 DOI: 10.1371/journal.pone.0219922] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background Hepatitis B (HBV) or hepatitis C (HCV) virus co-infections in HIV are alarming during pregnancy due to the risk of vertical transmission and the eventual adverse effects on neonates. This study was conducted to ascertain the sero-prevalence of HIV/HBV and HIV/HCV co-infections, evaluate the effect of the co-infections on the immunological and virological characteristics and assess the association between some demographic and lifestyle characteristics and risk of HBV, HCV, HIV/HBV and HIV/HCV co-infections among pregnant women living in the Brong-Ahafo Region of Ghana. Methods This comparative cross-sectional study was conducted at the anti-retroviral therapy (ART) clinics of the St. Elizabeth Hospital and the Holy Family Hospital, Brong-Ahafo Region, Ghana. A total of 248 consecutive consenting pregnant Ghanaian women, 148 diagnosed with HIV [HIV (+)] and 100 who were HIV negative [HIV (-)], were recruited. Validated questionnaire was used to obtain demographic and lifestyle data. Venous blood samples were obtained and HCV status, HBV profile, CD4+ T cell count, and HIV-1 RNA load were determined. Results The sero-prevalence of HIV (+) /HBV, HIV (+) /HCV, HIV (-)/HBV, and HIV (-)/HCV infections were 22 (14.9%), 6 (4.1%), 10 (10.0%), and 12 (12.0%) respectively. HIV-1 viral load was not significantly different between HIV/HBV, HIV/HCV co-infection and HIV mono-infection. However, CD4+ T lymphocyte count (364 vs 512 vs 514 cells/μl; p = 0.0009) was significantly lower in HIV/HBV co-infection compared to HIV/HCV and HIV mono-infection respectively. There was no significant association between demographic and lifestyle characteristics and risk of HBV and HCV infections in HIV positive and negative subjects except for late diagnosis of HIV and history of sharing razors blades and pins, where increased odds of HIV (+) /HBV and HIV (-)/HBV infection were observed. Conclusions The prevalence of HIV (+)/HBV (14.9%), HIV (+)/HCV (4.1%), HIV (-)/HBV (10.0%), and HIV (-)/HCV (12.0%) are high among pregnant women in the Brong Ahafo Region of Ghana. HIV/HBV is associated with reduced CD4+ T lymphocyte count but not HIV-1 viral load. Early diagnosis of HIV and intensification of routine antenatal HBV and HCV are essential to abate the risk of maternal to child transmission.
Collapse
Affiliation(s)
- Margaret T. Frempong
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Paul Ntiamoah
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Max Efui Annani-Akollor
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail:
| | - William K. B. A. Owiredu
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Otchere Addai-Mensah
- Department of Medical Diagnostics, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Eddie-Williams Owiredu
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Lorraine Sallah
- Department of Physiology, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| |
Collapse
|
25
|
Alvi Y, Khalique N, Ahmad A, Khan HS, Faizi N. World Health Organization Dimensions of Adherence to Antiretroviral Therapy: A Study at Antiretroviral Therapy Centre, Aligarh. Indian J Community Med 2019; 44:118-124. [PMID: 31333288 PMCID: PMC6625256 DOI: 10.4103/ijcm.ijcm_164_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Accepted: 03/05/2019] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION With the availability of antiretroviral therapy (ART) and subsequent change in the HIV/AIDS disease dynamic to a chronic manageable disease, adherence studies have received increasing attention. However, there is a paucity of studies that have considered World Health Organization (WHO) dimensions of adherence to ART. Therefore, this study was conducted with the objectives of determining the prevalence of adherence and the association of various factors across five WHO dimensions to adherence. METHODS A cross-sectional study was carried out at the ART Centre, Aligarh. A total of 440 adult patients, taking treatment from the ART Centre, Aligarh were selected. A self-reported instrument of missing pills was used to measure adherence. Various factors across five WHO dimensions were studied. RESULTS Prevalence of adherence in our study was 81.3%. Among the five dimensions of adherence, distance from home (odds ratio [OR] 0.980; 95% confidence interval [CI] 0.964-0.997) among socioeconomic determinants, frequent adherence counseling (OR 8.737; 95% CI 4.076-18.727) among health system-related, drug regimen (OR 2.202; 95% CI 1.023-4.738) and absence of side effects (OR 3.293; 95% CI 1.473-7.365) among therapy related, absence of substance abuse (OR 2.747; 95% CI 1.209-6.243), and perceived change in health status (OR 4.196; 95% CI 1.613-10.915) among patient-related dimension were found to be significantly associated with adherence to ART, while clinical condition dimension did not play a significant role. CONCLUSION The ART adherence rate is still below satisfactory levels for long-term viral load suppression. WHO multidimensional approach - which was found to be quite relevant in our study setting - could be applied to effectively solve the adherence problem in our country.
Collapse
Affiliation(s)
- Yasir Alvi
- Department of Community Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Najam Khalique
- Department of Community Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Anees Ahmad
- Department of Community Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| | - Haroon Subhan Khan
- Department of Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
- Nodal Officer, ART Centre, Aligarh, Uttar Pradesh, India
| | - Nafis Faizi
- Department of Community Medicine, Jawaharlal Nehru Medical College and Hospital, Aligarh Muslim University, Aligarh, Uttar Pradesh, India
| |
Collapse
|
26
|
Laar AK, Kwara A, Nortey PA, Ankomah AK, Okyerefo MPK, Lartey MY. Use of Non-Prescription Remedies by Ghanaian Human Immunodeficiency Virus-Positive Persons on Antiretroviral Therapy. Front Public Health 2017; 5:115. [PMID: 28603710 PMCID: PMC5445137 DOI: 10.3389/fpubh.2017.00115] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 05/02/2017] [Indexed: 11/13/2022] Open
Abstract
Background Inappropriate use of non-prescription remedies by persons living with human immunodeficiency virus (PLHIV) may result in adverse events or potentiate non-adherence to prescribed medications. This study investigated the use of non-prescription remedies among PLHIV receiving antiretroviral therapy (ART) from four treatment centers in southern Ghana. Methods A mixed method design using quantitative and qualitative methods was used. This article focuses on the quantitative survey of 540 respondents. Univariate analysis was used to generate descriptive tabulations of key variables. Bivariate analysis and logistic regression modeling, respectively, produced unadjusted and adjusted associations between background attributes of PLHIV and the use of non-prescription remedies. A p-value of < 0.05 was considered statistically significant. All analyses were performed using IBM SPSS Statistics for Windows, Version 20.0. Results One out of three respondents reported the use of non-prescription remedies at least once within 3 months of the survey. Most of these were locally made and included “Angel natural bitters, concoctions from the Christian prayer centers, garlic, and mahogany syrups.” These remedies were used concomitantly with antiretroviral medications (ARVs)—46% or administered with ARVs but at different times during the day (43%). Some of the remedies were reportedly prescribed by health workers, or self-initiated during periods of ARVs shortage. Others took them based on their perception of their efficacy. Bivariate level analysis identified ART clinic site, place of residence, and ARV adherence monitoring to be significantly associated with the use of non-prescription remedies (p < 0.05). Multiple logistic regression analysis controlling for covariates confirmed the location of ART clinic as the only predictor of the use of non-prescription remedies. Compared to clients at the large urban teaching hospital (Korle-Bu Fevers Unit ART center), those at the district level (Atua ART center) were ninefold more likely to use non-prescription remedies [adjusted odds ratio (AOR) = 8.84; 95% confidence interval (CI) 2.83–33.72]. Those from a district level mission hospital (St. Martin’s ART center) were threefold as likely to use these remedies (AOR = 2.610; 95% CI 1.074–9.120). Conclusion The use of non-prescription remedies by PLHIV on ART is common in southern Ghana. Usage is mostly self-initiated because of perceived efficacy of remedy, and was more common among clients attending rural ART clinics.
Collapse
Affiliation(s)
- Amos K Laar
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Awewura Kwara
- Department of Medicine, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Priscillia A Nortey
- Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana
| | - Augustine K Ankomah
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | | | - Margaret Y Lartey
- Department of Medicine, University of Ghana School of Medicine and Dentistry, University of Ghana, Accra, Ghana
| |
Collapse
|
27
|
Antiretroviral Treatment Adherence: Knowledge and Experiences among Adolescents and Young Adults in Soweto, South Africa. AIDS Res Treat 2017; 2017:5192516. [PMID: 28409026 PMCID: PMC5376918 DOI: 10.1155/2017/5192516] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 02/21/2017] [Indexed: 11/17/2022] Open
Abstract
Human immunodeficiency virus (HIV) management of adolescents and young adults (AYAs) is particularly pertinent to sub-Saharan Africa, where the pediatric HIV burden is marked. Antiretroviral treatment (ART) adherence is a major challenge for AYAs. This qualitative study explored knowledge and experiences of adherence amongst AYAs attending treatment at the Perinatal HIV Research Unit (PHRU), Soweto, South Africa. Four focus group discussions (FGDs) and eight in-depth interviews (IDIs) were conducted with HIV-infected 15-25-year-old ART recipients. Transcripts were coded thematically. Participants (n = 26) were aged median 18.5 years, 59.1% female and 69.2% virally suppressed <400 cp/ml. Three main themes emerged during FGDs and IDIs: (i) correct knowledge about how to be adherent, benefits, and nonadherence consequences, (ii) social, personal, and medication-related barriers to adherence, and (iii) reminder, concealment, and motivational strategies to optimize adherence. Interventions to improve AYA adherence could focus on practical strategies, including status disclosure and medication concealment.
Collapse
|
28
|
Heestermans T, Browne JL, Aitken SC, Vervoort SC, Klipstein-Grobusch K. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review. BMJ Glob Health 2016; 1:e000125. [PMID: 28588979 PMCID: PMC5321378 DOI: 10.1136/bmjgh-2016-000125] [Citation(s) in RCA: 192] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/30/2016] [Accepted: 11/01/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The rapid scale up of antiretroviral treatment (ART) in sub-Saharan Africa (SSA) has resulted in an increased focus on patient adherence. Non-adherence can lead to drug-resistant HIV caused by failure to achieve maximal viral suppression. Optimal treatment requires the identification of patients at high risk of suboptimal adherence and targeted interventions. The aim of this review was to identify and summarise determinants of adherence to ART among HIV-positive adults. DESIGN Systematic review of adherence to ART in SSA from January 2002 to October 2014. METHODS A systematic search was performed in 6 databases (PubMed, Cochrane Library, EMBASE, Web of Science, Popline, Global Health Library) for qualitative and quantitative articles. Risk of bias was assessed. A meta-analysis was conducted for pooled estimates of effect size on adherence determinants. RESULTS Of the 4052 articles screened, 146 were included for final analysis, reporting on determinants of 161 922 HIV patients with an average adherence score of 72.9%. Main determinants of non-adherence were use of alcohol, male gender, use of traditional/herbal medicine, dissatisfaction with healthcare facility and healthcare workers, depression, discrimination and stigmatisation, and poor social support. Promoters of adherence included counselling and education interventions, memory aids, and active disclosure among people living with HIV. Determinants of health status had conflicting influence on adherence. CONCLUSIONS The sociodemographic, psychosocial, health status, treatment-related and intervention-related determinants are interlinked and contribute to optimal adherence. Clinics providing ART in SSA should therefore design targeted interventions addressing these determinants to optimise health outcomes.
Collapse
Affiliation(s)
- Tessa Heestermans
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Joyce L Browne
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Susan C Aitken
- Ndlovu Research Consortium, Elandsdoorn, South Africa
- Department of Medical Microbiology, University Medical Centre Utrecht, The Netherlands
| | - Sigrid C Vervoort
- University Medical Centre Utrecht Cancer Center, Utrecht, The Netherlands
| | - Kerstin Klipstein-Grobusch
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Division of Epidemiology & Biostatistics, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
29
|
Mukui IN, Ng’ang’a L, Williamson J, Wamicwe JN, Vakil S, Katana A, Kim AA. Rates and Predictors of Non-Adherence to Antiretroviral Therapy among HIV-Positive Individuals in Kenya: Results from the Second Kenya AIDS Indicator Survey, 2012. PLoS One 2016; 11:e0167465. [PMID: 27907114 PMCID: PMC5131960 DOI: 10.1371/journal.pone.0167465] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 11/15/2016] [Indexed: 11/28/2022] Open
Abstract
Introduction Understanding the levels and associated factors of non-adherence to antiretroviral therapy (ART) is crucial in designing interventions to improve adherence and health outcomes of ART. We assessed non-adherence to ART among HIV-infected persons reporting ART use in a nationally representative survey in Kenya. Methods The Kenya AIDS Indicator Survey 2012 was a population-based, household survey of persons aged 18 months-64 years conducted in 2012–2013. Self-reported information was collected on demographics, sexual behaviour, HIV status, and ART use. Blood was collected for HIV testing, and if HIV infected, CD4 and viral load testing. HIV-positive specimens were tested for the presence of antiretroviral (ARV) drugs using a qualitative ARV assay using liquid chromatography-tandem mass spectrometry. HIV-positive persons who reported receiving ART but did not have the ARV biomarker present were defined as being non-adherent to their ARV medication. We restricted our analysis to HIV-infected persons aged 15–64 years who reported receiving ART and had laboratory-confirmed results from ARV testing. Multivariate logistic regression was used to identify variables associated with non-adherence. Results A total of 648 (5.6%; CI 4.9–6.3) tested HIV-positive of whom 559 (86.3%) had sufficient volume of blood to be tested for ARV drugs. Of those, 271 (47.7%; CI 41.8–53.6) self-reported HIV-positive status during the interview and 186 (69.1%; CI 62.2–76.0) of those reported taking ART. The ARV biomarker was absent in 18 of 186 individuals (9.4%; CI 4.9–13.8) who thus were defined as being non-adherent to ART. Non-adherence was associated with being aged 15–29 years (AOR 8.39; CI 2.26–31.22, p = 0.002) compared to aged 30–64 years, rural residence (AOR 5.87; CI 1.39–25.61, p = 0.016) compared with urban residence and taking recreational drugs in the past 30 days (AOR 5.89; CI 1.30–26.70, p = 0.022). Conclusion Overall, less than 10% of Kenyans aged 15–64 years on ART were not adhering to their HIV medication, highlighting the success of the Kenyan national ART program. Our findings, however, point to the need for targeted interventions particularly for young persons, those in rural areas to improve adherence outcomes, as well as delivery of treatment programs that include psychosocial support as a preventative measure to minimize substance abuse and the risk of treatment failure.
Collapse
Affiliation(s)
- Irene N. Mukui
- National AIDS & STI Control Programme, Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
- * E-mail:
| | - Lucy Ng’ang’a
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - John Williamson
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Joyce N. Wamicwe
- National AIDS & STI Control Programme, Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
| | - Shobha Vakil
- National AIDS & STI Control Programme, Department of Preventive and Promotive Health Services, Ministry of Health, Nairobi, Kenya
| | - Abraham Katana
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Andrea A. Kim
- Division of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| |
Collapse
|
30
|
Anaemia and Iron Homeostasis in a Cohort of HIV-Infected Patients: A Cross-Sectional Study in Ghana. AIDS Res Treat 2016; 2016:1623094. [PMID: 27092270 PMCID: PMC4820609 DOI: 10.1155/2016/1623094] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/29/2016] [Accepted: 03/01/2016] [Indexed: 11/18/2022] Open
Abstract
Aim. We determined the prevalence of anaemia and evaluated markers of iron homeostasis in a cohort of HIV patients. Methods. A comparative cross-sectional study on 319 participants was carried out at the Tamale Teaching Hospital from July 2013 to December 2013, 219 patients on HAART (designated On-HAART) and 100 HAART-naive patients. Data gathered include sociodemography, clinical history, and selected laboratory assays. Results. Prevalence of anaemia was 23.8%. On-HAART participants had higher CD4/CD3 lymphocyte counts, Hb, HCT/PCV, MCV, MCH, iron, ferritin, and TSAT (P < 0.05). Hb, iron, ferritin, and TSAT decreased from grade 1 to grade 3 anaemia and CD4/CD3 lymphocyte count was lowest in grade 3 anaemia (P < 0.05). Iron (P = 0.0072) decreased with disease severity whilst transferrin (P = 0.0143) and TIBC (P = 0.0143) increased with disease severity. Seventy-six (23.8%) participants fulfilled the criteria for anaemia, 86 (26.9%) for iron deficiency, 41 (12.8%) for iron deficiency anaemia, and 17 (5.3%) for iron overload. The frequency of anaemia was higher amongst participants not on HAART (OR 2.6 for grade 1 anaemia; OR 3.0 for grade 3 anaemia). Conclusion. In this study population, HIV-associated anaemia is common and is related to HAART status and disease progression. HIV itself is the most important cause of anaemia and treatment of HIV should be a priority compared to iron supplementation.
Collapse
|
31
|
Tello-Velásquez JR, Díaz-Llanes BE, Mezones-Holguín E, Rodríguez-Morales AJ, Huamaní C, Hernández AV, Arévalo-Abanto J. [Poor quality of sleep associated with low adherence to highly active antiretroviral therapy in Peruvian patients with HIV/AIDS]. CAD SAUDE PUBLICA 2015; 31:989-1002. [PMID: 26083174 DOI: 10.1590/0102-311x00010014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 12/01/2014] [Indexed: 01/25/2023] Open
Abstract
This cross-sectional study analyzed the association between poor quality of sleep and adherence to highly active antiretroviral therapy (HAART) in 389 Peruvian patients with HIV/AIDS. Poor quality of sleep was measured with the Pittsburgh Sleep Quality Index (PSQI) and adherence with the CEAT-VIH (Peruvian adaptation). A Poisson generalized linear model with robust standard errors was used to estimate prevalence ratios and 95%CI. A crude model showed that mild, moderate, and severe poor quality of sleep were associated with inadequate treatment adherence. In the adjusted model for variables associated in the bivariate analysis or variables theoretically associated with adherence, only moderate/severe poor quality of sleep remained associated (PR = 1.34, 95%CI: 1.17-1.54; and PR = 1.34, 95%CI: 1.16-1.57, respectively). The study concluded that moderate/severe poor quality of sleep was independently associated with adherence to HAART. Assessing quality of sleep may be helpful in the comprehensive evaluation of HIV patients.
Collapse
Affiliation(s)
| | | | | | | | - Charles Huamaní
- Centro Nacional de Salud Pública, Instituto Nacional de Salud, Lima, Perú
| | - Adrián V Hernández
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima, Perú
| | | |
Collapse
|
32
|
Poudel KC, Buchanan DR, Amiya RM, Poudel-Tandukar K. Perceived Family Support and Antiretroviral Adherence in HIV-Positive Individuals: Results from a Community-Based Positive Living With HIV Study. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2015; 36:71-91. [PMID: 26525224 DOI: 10.1177/0272684x15614220] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The purpose of this study was to examine the association between perceived family support, either positive or negative, and adherence to antiretroviral medication regimens among HIV-positive individuals in the Kathmandu Valley, Nepal. We measured past 3-month antiretroviral adherence among 233 HIV-positive individuals, in relation to perceived family support, both positive (in terms of emotional and instrumental support) and negative (in the form of negative interactions), using the 10-item Nepali Family Support and Difficulty Scale. Medium and high levels of perceived emotional support from family were associated with reduced risk of antiretroviral nonadherence, compared with low levels of perceived emotional support (adjusted odds ratio [AOR] = 0.37, 95% confidence interval [CI] [0.16, 0.88], and AOR = 0.23, 95% CI [0.08, 0.64], respectively). Conversely, higher levels of felt emotional distance (AOR = 1.46, 95% CI [1.00, 2.14]) and experienced physical harm (AOR = 2.04, 95% CI [1.07, 3.91]) were associated with increased risk of nonadherence. The results support the recommendation that service providers need to be aware of the significant role of family support in shaping antiretroviral adherence and to consider ways to strengthen positive family support while minimizing negative family interactions to increase adherence rates.
Collapse
Affiliation(s)
- Krishna C Poudel
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, MA, USA
| | - David R Buchanan
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, MA, USA The Institute for Global Health, University of Massachusetts Amherst, MA, USA
| | - Rachel M Amiya
- Department of Family Nursing, Graduate School of Medicine, The University of Tokyo, Japan
| | | |
Collapse
|
33
|
Dyrehave C, Rasmussen DN, Hønge BL, Jespersen S, Correia FG, Medina C, Wejse C, Rodkjaer L. Nonadherence is Associated with Lack of HIV-Related Knowledge: A Cross-Sectional Study among HIV-Infected Individuals in Guinea-Bissau. J Int Assoc Provid AIDS Care 2015; 15:350-8. [PMID: 26297492 DOI: 10.1177/2325957415599211] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Poor treatment adherence is a main barrier for effective antiretroviral therapy (ART) globally. HIV-related knowledge may affect understanding and utilization of HIV medical information, hence limited health literacy is a known barrier to treatment adherence. DESIGN AND METHODS A cross-sectional study included 494 HIV-infected individuals from the Bissau HIV Cohort in Guinea-Bissau. They completed a questionnaire designed for assessment of adherence and HIV-related knowledge. RESULTS A majority were female, 41% were illiterate, 25% did not take the medicine during the last 4 days, and 23% skipped their medicine during weekends. The most frequent reasons for not taking medicine were simply forgetting, side effects, lack of food, and being too ill to attend the clinic. Nonadherent patients had a lower level of HIV-related knowledge. CONCLUSION Main barriers for nonadherence were side effects, food insecurity, and simply forgetting. Lack of HIV-related knowledge about ART and HIV may be a barrier to nonadherence.
Collapse
Affiliation(s)
- Charlotte Dyrehave
- Bandim Health Project, In-depth Network, Bissau, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Dlama Nggida Rasmussen
- Bandim Health Project, In-depth Network, Bissau, Guinea-Bissau Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Bo Langhoff Hønge
- Bandim Health Project, In-depth Network, Bissau, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Sanne Jespersen
- Bandim Health Project, In-depth Network, Bissau, Guinea-Bissau Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Faustino Gomes Correia
- Centro de Tratamento Ambulatorio(CTA), Hospital Nacional Simão Mendes, Bissau, Guinea-Bissau
| | - Candida Medina
- Centro de Tratamento Ambulatorio(CTA), Hospital Nacional Simão Mendes, Bissau, Guinea-Bissau
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark Centro de Tratamento Ambulatorio(CTA), Hospital Nacional Simão Mendes, Bissau, Guinea-Bissau Centres of Global Health, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lotte Rodkjaer
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | | |
Collapse
|
34
|
Osakunor DNM, Obirikorang C, Fianu V, Asare I, Dakorah M. Hepatic Enzyme Alterations in HIV Patients on Antiretroviral Therapy: A Case-Control Study in a Hospital Setting in Ghana. PLoS One 2015; 10:e0134449. [PMID: 26247879 PMCID: PMC4527699 DOI: 10.1371/journal.pone.0134449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 07/10/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Diagnosing hepatic injury in HIV infection can be a herculean task for clinicians as several factors may be involved. In this study, we sought to determine the effects of antiretroviral therapy (ART) and disease progression on hepatic enzymes in HIV patients. METHODS A case-control study conducted from January to May 2014 at the Akwatia Government Hospital, Eastern region, Ghana, The study included 209 HIV patients on ART (designated HIV-ART) and 132 ART-naive HIV patients (designated HIV-Controls). Data gathered included demography, clinical history and results of blood tests for hepatic enzymes. We employed the Fisher's, Chi-square, unpaired t-test and Pearson's correlation in analysis, using GraphPad Prism and SPSS. A P value < 0.05 was considered significant. RESULTS Median CD4 lymphocyte count of HIV-ART participants (604.00 cells/mm3) was higher than that of HIV-Controls (491.50 cells/mm3; P = 0.0005). Mean values of ALP, ALT, AST and GGT did not differ between the two groups compared (P > 0.05). There was a significant positive correlation between hepatic enzymes (ALP, ALT, AST and GGT) for both groups (p < 0.01 each). Duration of ART correlated positively with ALT (p < 0.05). The effect size of disease progression on hepatic enzymes for both groups was small. CONCLUSION Antiretroviral therapy amongst this population has minimal effects on hepatic enzymes and does not suggest modifications in therapy. Hepatic injury may occur in HIV, even in the absence of ART and other traditional factors. Monitoring of hepatic enzymes is still important in HIV patients.
Collapse
Affiliation(s)
- Derick Nii Mensah Osakunor
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Christian Obirikorang
- Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Vincent Fianu
- Department of Medical Laboratory Technology, Faculty of Allied Health Sciences, Kwame Nkrumah University of Sciences and Technology, Kumasi, Ghana
| | - Isaac Asare
- Medical Laboratory Department, St. Dominic Catholic Hospital, Akwatia, Ghana
| | - Mavis Dakorah
- Medical Laboratory Department, St. Dominic Catholic Hospital, Akwatia, Ghana
| |
Collapse
|
35
|
Factors Influencing Antiretroviral Adherence and Virological Outcomes in People Living with HIV in the Highlands of Papua New Guinea. PLoS One 2015; 10:e0134918. [PMID: 26244516 PMCID: PMC4526685 DOI: 10.1371/journal.pone.0134918] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/15/2015] [Indexed: 11/24/2022] Open
Abstract
Adherence to antiretroviral therapy (ART) is paramount for virological suppression and positive treatment outcomes. ART has been rapidly scaled up in Papua New Guinea (PNG) in recent years, however clinical monitoring of HIV+ individuals on ART is limited. A cross-sectional study was conducted at two major sexual health clinics in high HIV prevalence provinces in the Highlands Region of PNG to assess ART adherence, factors affecting adherence and the relationship between ART adherence and virological outcomes. Ninety-five HIV+ individuals were recruited and administered a questionnaire to gather demographic and ART adherence information whilst clinical data and pill counts were extracted from patient charts and blood was collected for viral load testing. Bivariate analysis was performed to identify independent predictors of ART adherence. Fourteen percent (n = 12) of participants showed evidence of virological failure. Although the majority of participants self-reported excellent ART adherence in the last seven days (78.9%, 75/91), pill count measurements indicated only 40% (34/84) with >95% adherence in the last month. Taking other medications while on ART (p = 0.01) and taking ART for ≥1 year (p = 0.037) were positively associated with adherence by self-report and pill count, respectively. Participants who had never heard of drug resistance were more likely to show virological failure (p = 0.033). Misconception on routes of HIV transmission still persists in the studied population. These findings indicate that non-adherence to ART is high in this region of PNG and continued education and strategies to improve adherence are required to ensure the efficacy of ART and prevent HIV drug resistance.
Collapse
|
36
|
Yaya I, Landoh DE, Saka B, Patchali PM, Wasswa P, Aboubakari AS, N'Dri MK, Patassi AA, Kombaté K, Pitche P. Predictors of adherence to antiretroviral therapy among people living with HIV and AIDS at the regional hospital of Sokodé, Togo. BMC Public Health 2014; 14:1308. [PMID: 25526773 PMCID: PMC4300825 DOI: 10.1186/1471-2458-14-1308] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 12/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adherence to antiretroviral therapy (ART) is beneficial in reducing the risk of emergence of HIV resistant strains. Adherence to ART among Persons Living with HIV/AIDS (PLWHA) is influenced by several factors related to the patient, the medication, and health facilities. In Togo, previous studies on adherence to ART have reported good adherence to ART during the first year of follow-up. However these may hide many disparities dues to cultural specificities which may differ across geographic areas of the country. We sought to determine the level of adherence to ART and document the associated factors among PLWHA at the regional hospital of Sokodé, Togo. METHODS This was an analytical cross-sectional study conducted from May to July 2013 at the regional hospital of Sokodé among 291 PLWHA who had been on ART for at least three months before the study. RESULTS A total of 291 PLWHA on ART were enrolled in the study. The mean age (±SD) was 37.3 ± 9.3 years and the sex ratio (Male/Female) was 0.4. Among them, 195 (67.0%) were living with their partners and 210 (72.2%) had formal education. Two-thirds (194/291; 66.7%) of the PLWHA interviewed lived in urban areas. The global adherence to ART was 78.4%; the factors associated with ART adherence were: level of education (aOR = 3.54; p = 0.027), alcohol consumption (aOR = 0.43; p = 0.033), ART perception (aOR = 2.90; p = 0.026) and HIV status disclosure to sexual partner (aOR = 7.19; p ≤ 0.001). CONCLUSION Although the level of adherence to ART in this study was higher than those reported in some studies in Sub-Saharan Africa, it remains sub-optimal and needs improvement. This may therefore hinder the implementation of efficient interventions related to access to ART services.
Collapse
Affiliation(s)
| | - Dadja Essoya Landoh
- Division de l'Epidémiologie, Ministère de la Santé, S/C INH - Togo, BP 1396 Lomé, Togo.
| | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Ramadhani HO, Bartlett JA, Thielman NM, Pence BW, Kimani SM, Maro VP, Mwako MS, Masaki LJ, Mmbando CE, Minja MG, Lirhunde ES, Miller WC. Association of first-line and second-line antiretroviral therapy adherence. Open Forum Infect Dis 2014; 1:ofu079. [PMID: 25734147 PMCID: PMC4281791 DOI: 10.1093/ofid/ofu079] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 08/03/2014] [Indexed: 11/15/2022] Open
Abstract
Adherence to first-line ART is an important predictor of adherence to second-line ART. Improving adherence prior to switch is critical to improve patient outcomes. Background Adherence to first-line antiretroviral therapy (ART) may be an important indicator of adherence to second-line ART. Evaluating this relationship may be critical to identify patients at high risk for second-line failure, thereby exhausting their treatment options, and to intervene and improve patient outcomes. Methods Adolescents and adults (n = 436) receiving second-line ART were administered standardized questionnaires that captured demographic characteristics and assessed adherence. Optimal and suboptimal cumulative adherence were defined as percentage adherence of ≥90% and <90%, respectively. Bivariable and multivariable binomial regression models were used to assess the prevalence of suboptimal adherence percentage by preswitch adherence status. Results A total of 134 of 436 (30.7%) participants reported suboptimal adherence to second-line ART. Among 322 participants who had suboptimal adherence to first-line ART, 117 (36.3%) had suboptimal adherence to second-line ART compared with 17 of 114 (14.9%) who had optimal adherence to first-line ART. Participants who had suboptimal adherence to first-line ART were more likely to have suboptimal adherence to second-line ART (adjusted prevalence ratio, 2.4; 95% confidence interval, 1.5–3.9). Conclusions Adherence to first-line ART is an important predictor of adherence to second-line ART. Targeted interventions should be evaluated in patients with suboptimal adherence before switching into second-line therapy to improve their outcomes.
Collapse
Affiliation(s)
- Habib O Ramadhani
- Kilimanjaro Christian Medical Centre , Moshi , Tanzania ; Department of Epidemiology , University of North Carolina , Chapel Hill
| | - John A Bartlett
- Division of Infectious Diseases and International Health, Department of Medicine , Duke University Medical Center ; Duke Global Health Institute , Durham, North Carolina
| | - Nathan M Thielman
- Division of Infectious Diseases and International Health, Department of Medicine , Duke University Medical Center ; Duke Global Health Institute , Durham, North Carolina
| | - Brian W Pence
- Department of Epidemiology , University of North Carolina , Chapel Hill
| | | | | | | | | | | | - Mary G Minja
- Kibosho Designated District Hospital , Moshi , Tanzania
| | | | - William C Miller
- Department of Epidemiology , University of North Carolina , Chapel Hill
| |
Collapse
|