Adherence to antiretroviral therapy and associated factors among Human immunodeficiency virus positive patients accessing treatment at Nekemte referral hospital, west Ethiopia, 2019

Perception of medical care among women living with HIV aged 40 years or older-A European-wide survey

OBJECTIVES

Our objective was to explore how women living with HIV aged ≥40 years perceive their care in relation to their HIV infection, comorbidities, and menopausal health and to evaluate the extent to which the care they receive meets their expectations, comparatively across World Health Organization (WHO) European regions.

METHODS

We conducted a cross-sectional survey (May-December 2023) among women living with HIV aged ≥40 years from the WHO European region. Five dimensions of care were assessed: content of care, information, relationship with caregiver, organization of care, and patients' rights and privacy, in addition to management of non-HIV comorbidities and menopause.

RESULTS

In total, 600 women completed the survey; they were predominantly from the Western European region (70.2%), followed by the Eastern (20.2%) and Central (9.6%) regions. The majority of women (46.5%-95.1%) described positive experiences, responding that they were 'always' or 'usually' satisfied with the five dimensions of HIV care. The concordance between perceptions and experiences of HIV care ranged from 49.4% to 96.1% and was lower in the Eastern region. Among menopausal women, 58.5% were 'very satisfied' or 'satisfied' with the care they received; satisfaction was significantly lower in Eastern European countries than in Western countries.

CONCLUSIONS

Our results highlighted a generally high concordance between respondents' expectations and the services provided, including both HIV and non-HIV care. Women aged ≥40 years living with HIV face several challenges that should be addressed. These findings inform stakeholders and decision-makers about the need to adopt a more inclusive and sensitive approach in healthcare systems.

Determinants of adherence to antiretroviral therapy among people living with HIV receiving care in health facilities in Tamale Metropolis, Ghana

BACKGROUND

Strictly following antiretroviral therapy (ART) is essential in managing HIV and AIDS and attaining viral suppression. However, adherence to ART remains a complex challenge among persons living with HIV (PLHIV) and it is influenced by various individual and socio-cultural factors. Also, there is limited data as far as the studies on determinants of ART adherence in the Tamale Metropolis is concerned. This highlights a critical knowledge gap that needs to be addressed to improve adherence rates. This study therefore aims to examine the determinants of ART adherence among PLHIV in the Tamale Metropolis, Ghana.

METHODS

A facility-based cross-sectional study design was conducted from November 2023 to February 2024 to recruit 418 PLHIV using consecutive sampling from three healthcare facilities located in the Tamale Metropolis. Data were collected on demographic characteristics, adherence behaviours and socio-cultural beliefs. Every element impacting adherence to ART underwent assessment using a 4-point Likert scale, with data entry and coding executed using Microsoft Excel, followed by statistical analyses using SPSS version 21. Fisher's exact test, Chi-square test and multiple logistic regression analyses were utilized to ascertain autonomous indicators of ART adherence while accounting for the impact of other factors. Determinants of ART were considered statistically significant at a p-value of less than 0.05 with a 95% confidence interval.

RESULTS

A total of 418 PLHIV were studied, yielding a 100% response rate and an ART adherence rate of 93%, with a 95% confidence interval ranging from 90.6% to 95.4%. Clients who were educated (AOR = 6.80, 95% CI: 1.57-29.42, p = 0.010), retentive (AOR = 10.73, 95% CI: 4.24-27.15, p < 0.001), had aversion for alternative treatment modalities (AOR = 8.04, 95% CI: 2.90-22.29, p < 0.001) and involved with peer support groups (AOR = 3.73, 95% CI: 1.02-13.56, p < 0.05) exhibited markedly higher rates of adherence to ART, as relative to those who did the opposite.

CONCLUSION

The study identified a sub-optimal adherence rate of 93% among PLHIV with key determinants of ART adherence. Among individual factors, educational attainment and forgetfulness played a significant role in influencing adherence levels. In terms of sociocultural factors, inclinations toward alternative therapies, such as traditional or herbal remedies, and active engagement in peer support networks were found to impact adherence. The Ghana AIDS Commission and its partners should implement targeted educational programs, interventions such as reminder systems (e.g., mobile phone alerts, pill organizers) should be developed and promoted, develop culturally sensitive outreach programs that respect traditional beliefs while promoting the benefits of ART and strengthen peer support networks.

Assessment of Health-Related Quality of Life in Adults Living with HIV Attending Antiretroviral Clinics versus Traditional Healers' Offices in Bukavu City, Democratic Republic of the Congo

Background

The benefits of antiretroviral therapy (ART) for people living with HIV/AIDS (PLHIV) include immune system strengthening, viral load suppression, and improved health-related quality of life (HRQOL). This present study compares the HRQOL of PLHIV visiting ART clinics versus that of PLHIV attending traditional healers (THs)' offices, assesses the adherence of PLHIV to ART, identifies possible predictors of nonadherence of PLHIV to ART and HRQOL, and estimates the proportion of patients with HIV referred by THs to health centers in Bukavu.

Patients and methods

Between February and June 2023, a cross-sectional comparative study was conducted on 150 adult PLHIV attending ART clinics and 150 adult PLHIV visiting THs' offices in the 3 urban health zones of Bukavu. The World Health Organization Quality of Life questionnaire (WHOQOL-BREF) and a self-report questionnaire measuring ART adherence were used to collect the data. Regression models were used to identify the predictors of no adherence to ART and the HRQOL of PLHIV.

Results

Compared with those attending THs, PLHIV attending ART clinics had higher mean scores in all HRQOL domains. Approximately 84% of the participants were compliant with ART. The predictors associated with nonadherence to ART included illiterate participants [OR=23.3 (95% CI=1.23-439.5), p=0.004] and divorced or separated participants [OR=10.3 (95% CI=1.12-94.4), p=0.034]. The proportion of PLHIV referred to ART clinics by THs was only 10.7%.

Conclusion

PLHIV visiting ART clinics had a better HRQOL than did PLHIV attending THs' offices. The rate of adherence to ART among PLHIV who attended ART clinics was high. It is recommended that PLHIV visiting THs be referred to ART clinics for improved HRQOL.

Exploring optimal HAART adherence rates in Ethiopian adults: a systematic review and meta-analysis

Background

Optimal medication adherence is vital for the successful implementation of highly active antiretroviral therapy (HAART) in managing HIV infection. Global efforts aim to minimize the burden of antimicrobial resistance (AMR), including HIV-associated drug resistance.

Methods

This systematic review and meta-analysis followed PRISMA guidelines and searched multiple databases for eligible studies published until July 10, 2023. Eligible studies focused on Ethiopians receiving HAART, reported the prevalence of optimal adherence, and used appropriate assessment tools. Quality of included studies was assessed using JBI checklists A weighted inverse variance random-effects model was applied to calculate the pooled prevalence.

Results

Our meta-analysis aimed to determine the pooled prevalence of optimum Highly Active Antiretroviral Therapy (HAART) adherence among HIV-positive adults in Ethiopia and explore variations based on assessment methods, recall periods, and regional factors. The estimated national pooled prevalence of optimal HAART adherence was 79% (95% CI: 74-83, I 2 = 98.1%; p-value < 0.001). Assessment methods revealed a prevalence of 64% (95% CI: 54-73) using structured assessment and 82% (95% CI: 78-86) with self-reporting. Optimum adherence varied based on recall periods, ranging from 78 to 85% with self-reporting. Heterogeneity analysis indicated substantial variation (I 2 = 98.1%; p-value < 0.001), addressed through subgroup analysis, sensitivity analysis, and univariate meta-regression. Subgroup analysis based on region identified varying prevalence: SNNPR (83%), Oromia (81%), Amhara (79%), and Addis Ababa (74%). Considering the 2018 guideline revision, year-based subgroup analysis showed a prevalence of 78% and 78% before and after 2018, respectively. Sensitivity analysis demonstrated the stability of results, with excluded studies having a minimal impact. Publication bias analysis indicated an absence of bias, as evidenced by a non-significant Egger's regression test (p-value = 0.002) and no adjustment in trim and fill analysis.

Conclusions

The estimated overall prevalence of optimal adherence was 79%, indicating a substantial level of adherence to HAART in the Ethiopian context. The study identified variations in adherence levels based on assessment methods and recall periods, highlighting the importance of considering these factors in evaluating adherence rates. These insights contribute valuable information for policymakers, healthcare practitioners, and researchers working toward enhancing HAART adherence in Ethiopia.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=459679.

Highly active antiretroviral therapy adherence among HIV-POSITIVE women in Southern Ethiopia

Background

Adherence to Highly Active Antiretroviral Therapy (HAART) medication is the major predictor of HIV/AIDS treatment success. Poor adherence to HAART creates the risk of transmitting HIV, deteriorating health conditions, treatment failure, increased occurrences of drug-resistant HIV, morbidity and mortality. The objective of the study was to explore and describe factors influencing HAART adherence among HIV-positive women in Southern Ethiopia.

Methods

A hospital-based descriptive cross-sectional survey was used among 220 randomly selected respondents. Data was collected with a structured interview guide after each respondent had given consent to take part in the study. The collected data was entered into and analyzed by using the Statistical Package for Social Sciences (SPSS) software program version 27.

Results

The level of self-reported adherence (measured by dose) to HAART in the past 30 days was found to be 82.7%. In multivariate analysis, the divorced/separated HIV-positive women had poor adherence to their HAART medication as compared to those who were married [AOR: 2.94, 95% CI: (1.02-8.44)]. Respondents who used reminders in their medication were 75% less likely to be poorly adherent to their HAART medication than those who did not use reminders [AOR: 0.25, 95% CI: (0.06-0.97)]. Those who self-reported depression, perceived stigma, and low perceived susceptibility had poor adherence to their HAART than those who did not report depression, perceived stigma, and low perceived susceptibility [AOR:2.34, 95% CI: (1.01-5.42)], [AOR:2.37, 95% CI: (1.06-5.34)], and [AOR: 4.1, 95% CI: (1.53-11.1)] respectively. HIV-positive women who self-reported low perceived severity were poorly adherent to HAART than those who self-reported high perceived severity [AOR: 2.92, 95% CI: (1.14-7.47)].

Conclusion

Factors including being divorced/separated, not using reminders, depression, perceived stigma, perceived susceptibility, and perceived severity negatively impact HIV-positive women's adherence to HAART.

Multilevel determinants of antiretroviral therapy initiation and retention in the test-and-treat era of Nepal: a qualitative study

BACKGROUND

The transition to the "test-and-treat" policy in Nepal in 2017, coupled with the rapid initiation of antiretroviral therapy (ART) in 2020, necessitates an in-depth understanding of factors influencing ART initiation and retention. This study investigates these factors from the perspectives of healthcare providers, families/communities, and people living with HIV (PLHIV).

METHODS

Employing a qualitative design, in-depth interviews were conducted with 24 ART clients and 26 healthcare providers across different provinces of Nepal. A comprehensive interview guide facilitated the exploration of experiences and perceptions. Interviews were transcribed verbatim, and thematic analysis was applied to distill key insights. Guided by a socio-ecological model, interviews were analyzed to identify the barriers and facilitators to ART initiation and continuation at the individual, family/community, and health system levels.

RESULTS

Facilitators and barriers were identified at three levels. Individual-level facilitators included fear of death, perceived health benefits, knowledge about HIV/ART, confidentiality, and financial support. Barriers encompassed concerns about lifelong medication, side effects, denial of HIV status, fear of disclosure, and financial constraints. At the family/community level, support from family and community health workers facilitated ART adherence, while social stigma and discrimination posed barriers. The health system's role was dual; the provision of free treatment, a client tracking system and a robust drug supply chain were facilitators, whereas logistical challenges and service accessibility during the COVID-19 pandemic were notable barriers.

CONCLUSIONS

This study highlights the various factors that influence ART initiation and retention in Nepal during the test-and-treat era. Tailored interventions should focus on increasing awareness about HIV and ART, strengthening healthcare systems, ensuring availability of medications, and providing accessible treatment during service disruptions. Furthermore, these interventions should encourage supportive environments at the individual, community, and healthcare system levels. Taking this holistic approach is essential for effectively implementing ART and achieving long-term health outcomes in light of changing public health policies.

Hospitalization and mortality outcomes among adult persons living with HIV in a tertiary hospital in South-western Nigeria: A cross-sectional study

HIV infection continues to be a major public health issue, with significant morbidity and mortality especially in resource poor areas. Infection with HIV results in an increased risk of opportunistic infections and other complications, which may lead to hospital admission and death. Morbidity and mortality patterns among hospitalized persons living with HIV (PLHIV) have been well documented in high income countries, but there is paucity of such data in Nigeria. We investigated the reasons for hospitalization and predictors of death among adult PLHIV at the Federal Medical Center (FMC) Abeokuta, Nigeria. This was a hospital based cross-sectional study carried out over a 15-month period between January 2018 and March 2019. All consenting hospitalized adult PLHIV who met the inclusion criteria were enrolled into the study. Causes of hospitalization and death were obtained and analyzed. Over the study period, 193 hospitalizations of PLHIV were studied. Although a number of clinical syndromes were documented, Sepsis and Tuberculosis were the commonest causes of hospitalization and mortality. Mortality rate was 37(19.2%) for outcomes on day 30, with anaemia [OR 3.00 (95% C.I: 1.04-8.67)], poor adherence with Cotrimoxazole [OR 4.07 (95% C.I: 1.79-9.28)], poor adherence with cART [OR 13.40 (95% C.I: 3.92-45.44)], and a longer duration of fever [OR 3.34 (95% C.I: 1.10-9.99)] being predictors of mortality. Part of the study's limitation was resource-constraint of some of the indigent patient which affected their ability to access some diagnostic investigations and get optimal care thereby impacting on their outcome. Despite the upscaling of cART, opportunistic infections and sepsis remain common causes of hospitalization and death in adult PLHIV. More attention should therefore be placed on early diagnosis, prevention of immunosuppression and sepsis through timely administration and adherence to cART and other prophylactic measures.

Level of antiretroviral therapy adherence and associated factors during COVID-19 pandemic era in public hospitals of Jigjiga City eastern Ethiopia: a cross-sectional study

Background

Coronavirus-19 disease is more severe in patients on antiretroviral therapy (ART). Low-income countries, such as those in Sub-Saharan Africa, are particularly vulnerable to the virus' spread. However, there is little information on antiretroviral therapy (ART) use in Ethiopia during the pandemic, particularly in the study area. Therefore, this study aimed to assess the level of antiretroviral treatment adherence and associated factors during the COVID-19 pandemic era in public hospitals in Jigjiga City, Somalia, and Eastern Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 382 randomly selected HIV patients on antiretroviral therapy (ART) follow-up in public hospitals in Jigjiga City from March 1-30, 2022. The data was collected through face-to-face interviews and a review of the patient's record. To explore the relationship between variables, both bivariate and multivariable logistic regression analyses were performed. The adjusted odds ratio (AOR) was utilized, along with a 95% confidence interval, to assess the strength and direction of the association. Statistical significance was considered at p < 0.05.

Results

The antiretroviral therapy (ART) adherence rate of HIV patients was 76.9% (95% CI, 71.9-82). Disclosing HIV status to sexual partners [AOR = 2.3, (95% CI (1.22-4.19)], having communication with health care providers' [AOR = 3.2, (95% CI (1.57-6.53)], having no history of current substance use [AOR = 2.6, (95% CI (1.45-4.63)], and patients who did not fear COVID-19 infection [AOR = 5.8 (95% CI (11-10.98)] were significantly associated with antiretroviral therapy (ART) adherence.

Conclusion

In this study, the level of antiretroviral therapy (ART) adherence was poor in comparison to the expected level. Patients' adherence status was favorably related to disclosing their status to families and having contact with their healthcare providers, whereas worrying about COVID-19 pandemic infection and current substance use was adversely associated.

Experiences of patients living with HIV and AIDS on antiretroviral therapy in Accra, Ghana

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.

Adherence to Anti-Retroviral Therapy (ART) and Its Determinants Among People Living with HIV/AIDS at Bonga, Kaffa, South-West Ethiopia

Background

The scaling-up of antiretroviral therapy (ART) is the greatest accomplishment to reduce the burden of acquired immunodeficiency syndromes (AIDS) to date. However, it requires optimal adherence to be effective. Thus, this study was designed to assess the level of adherence of people living with HIV (PLWH) to ART and its determinants in one of the hardest-hit areas with HIV in Ethiopia.

Methods

A health facility-based cross-sectional study design was conducted among adult PLWH, age >18 years, and receiving ART in southwest Ethiopia. Data was collected by face-to-face interviews following the Self-Rating Scale Item for drug adherence and from participants' medical cards. The effects of variables related to socio-demographic and socio-economic factors, disease and medication, health facilities, and patients' behavior on ART adherence were analyzed using a binary logistic regression model. The data was analyzed using R software.

Results

Self-reported good adherence to ART recorded in this study was 73.1% (n =301/412). The risk of poor adherence was significantly higher among those who were divorced, merchants, used ART for longer durationsand were found in stage IV WHO pathogenesis. Contrarily, those who had a positive perception of the effectiveness of ART had significantly better adherence to ART. Longer duration on ART and frequency of pills taken, ≥3 pills per day, were significantly associated with a low CD4+ cell count (<500 cells/mm3). For each unit increase in medication frequency per day, the likelihood of having a high viral load of >1000 copies/mL was 5.35 times higher.

Conclusion

The ART adherence documented in this study was graded as moderately low. Some variables, such as clinical, medical, and behavioral, were found to affect the adherence of people living with HIV to ART. Hence, care providers should be aware of such variables in the process of treatment, follow-up, and monitoring of people living with HIV in the study area.

Disparities in healthcare access and utilization among people living with HIV in China: A scoping review and meta-analysis

BACKGROUND

This review aims to assess the status of healthcare disparities among people living with HIV (PLWH) in China and summarize the factors that drive them.

METHODS

We searched PubMed, Web of Science, Cochrane Library, Scopus, China National Knowledge Infrastructure (CNKI) and China Wanfang for studies published in English or Chinese. Studies focusing on any disparities in healthcare services among PLWH in China and published between January 2000 and July 2022 were included.

RESULTS

In all, 51 articles met the inclusion criteria, with 37 studies reporting HIV-focused care, and 14 reporting non-HIV-focused care. PLWH aged ≥45 years (vs. <45 years), female (vs. male), ethnic minority (vs. Han), and cases attributed to sexual transmission (vs. injecting drug use) were more likely to receive ART. Females living with HIV have higher ART adherence than males. Notably, 20% [95% confidence interval (CI): 9-43%, I2  = 96%] of PLWH reported any illness in the previous 2 weeks without medical consultation, and 30% (95% CI: 12-74%, I2  = 90%) refused hospitalization when needed in the previous year. Barriers to HIV-focused care included inadequate HIV/ART knowledge and treatment side effects at the individual level; and social discrimination and physician-patient relationships at the community/social level. Structural barriers included medical costs and transportation issues. The most frequently reported barriers to non-HIV-focused care were financial constraints and the perceived need for medical services at individual-level factors; and discrimination from physicians, and medical distrust at the community/social level.

CONCLUSION

This review suggests disparities in access and utilization of healthcare among PLWH. Financial issues and social discrimination were prominent reasons. Creating a supportive social environment and expanding insurance policies could be considered to promote healthcare equity.

To explore patients’ perceptions about motivators and barriers of adherence to highly active antiretroviral therapy among people living with HIV: A qualitative study

Objective:

For people living with HIV (PLHIV), strict adherence to highly active antiretroviral therapy (HAART) is the key to effective treatment and retention in human immunodeficiency virus (HIV) care. There are many factors which promote or halt the antiretroviral therapy (ART) adherence practices. Therefore, the present study aimed to examine the HAART adherence levels and to explore patients’ views about barriers and facilitators to HIV treatment adherence.

Methods:

Semi-structured interviews were conducted among 15 PLHIV at the ART clinic of Dr. Ram Manohar Lohia Hospital, New Delhi. Interviews were audio-recorded in the local Hindi language, and bilingual experts (English and Hindi) transcribed verbatim. Qualitative data were coded for themes and subthemes and analyzed using a phenomenological approach as per thematic content analysis.

Results:

Feeling of hopelessness, delayed ART initiation, difficult initial phase of ART, forget to take ART on time, fear of disclosure of HIV diagnosis, lack of privacy and negative social support, and impact of lockdown due to COVID-19 were revealed as significant barriers to ART adherence. At the same time, commitment to raise and educate children, ART to increase life span, maintain oneself to be physically fit and healthy, only a single pill per day, very supportive counselors and health-care professionals, and hope to give birth to a healthy child were identified as facilitators of HIV retention.

Conclusion:

Understanding patient’s perception about ART adherence, its motivational and barrier factors which are directly affecting ART adherence and retention of PLHIV in HIV treatment and follow-ups are of utmost importance to improve ART adherence during HIV patient care services.

Navigating antiretroviral adherence in boarding secondary schools in Nairobi, Kenya: A qualitative study of adolescents living with HIV, their caregivers and school nurses

In Kenya, adolescents spend much of their formative years in boarding secondary schools, which presents a challenging environment for antiretroviral (ART) adherence support among adolescents living with HIV (ALHIV). We examined the experiences of ALHIV, caregivers of adolescents, and school nurses regarding navigating ART adherence in boarding secondary schools. Between July and November 2022, we conducted focus group discussions (FGDs) among ALHIV attending boarding schools in Nairobi, Kenya, and caregivers of ALHIV, and in-depth interviews (IDIs) with school nurses. Clinic records were used to identify ALHIV and caregivers, who were invited to participate based on their availability. We categorized boarding schools into national, county, and sub-county levels and selected two schools from each category. We obtained permission from head teachers and invited school nurses to take part in virtual IDIs. The interviews were audio-recorded, transcribed verbatim, and analyzed thematically. We conducted two FGDs with 11 caregivers, two FGDs with 18 adolescents, and 7 IDIs with school nurses. Most of the ALHIV reported having disclosed their HIV status to a school nurse or teacher during admission. School nurse friendliness, being understanding, fair, and confidential were qualities associated with ALHIV willingness to confide in them. Strategies ALHIV used to adhere to medication included: waiting until students were engaged in other activities, waking up early, stepping away from others, and stating their drugs were for different ailments. Caregivers were nervous about school-based adherence counseling, fearing it could lead to inadvertent disclosure of adolescents' HIV status and stigmatization by fellow students. All school nurses reported lacking appropriate training in HIV adherence counseling for adolescents. ALHIV have devised innovative strategies to navigate pill-taking and enlist quiet support while operating in stigmatized school environments. Establishment of a strong school nurse-adolescent rapport and building nurses' skills are key to improving school-based support for ALHIV.

Biographical Reinvention: An Asset-Based Approach to Understanding the World of Men Living with HIV in Indonesia

HIV diagnosis and management have often caused disruption to the everyday life and imagined futures of people living with HIV, both at individual and social levels. This disruption has been conceptualised, in a rather dystopian way, as 'biographical disruption'. This paper explores whether or not biographical disruption of living with HIV encourages men living with HIV (MLHIV; n = 40) in Yogyakarta and Belu, Indonesia, to reinvent their sense of self and future over time using internal and external assets. Our analysis uses the concepts of additive and subtractive resilience strategies, and we show how, rather than having a purely disrupted biography, participants talked about their experiences of 'biographical reinvention'. Study participants were recruited using the snowball sampling technique, beginning with two HIV clinics as the settings. Data were collected using one-on-one in-depth interviews, and a qualitative framework analysis was used to guide step-by-step data analysis. The findings showed that, despite the disruptions in their everyday lives (i.e., mental health condition, work, activities, social relationships, etc.) following the HIV diagnosis and management, MLHIV in our study managed to utilise their internal assets or traits (i.e., hope, optimism, resilience) and mobilised external resources (i.e., support from families, friends and healthcare professionals) to cope with the disruptions. An interweaving of these internal assets and external resources enabled them to take on new activities and roles (additive resilience strategies) and give up health compromising behaviours (subtractive resilience strategies). These were effective for most MLHIV in our study, not only to cope with the HIV repercussions and improve their physical and mental health conditions, but to think or work on a 'reinvented' biography which encompassed resilience, hope and optimism for better health, life and future. The findings indicate the need for HIV interventions and healthcare systems that provide appropriate support for the development and maintenance of internal assets of PLHIV to enable them to cope with the repercussions of HIV and work on a 'reinvented' biography.

What are the determinants of antiretroviral therapy adherence among stable people living with HIV? A cross-sectional study in Cambodia

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.

Factors Associated with Adherence to Treatment in Patients with HIV and Diabetes Mellitus

We aim to identify the factors that influence the therapeutic adherence of subjects with chronic disease. The design followed in this work was empirical, not experimental, and cross-sectional with a correlational objective. The sample consisted of a total of 400 subjects (199 patients with HIV and 201 patients with diabetes mellitus). The instruments applied for data collection were a sociodemographic data questionnaire, the 4-item Morisky Medication Adherence Scale (MMAS-4) and the Coping Strategies Questionnaire. In the group of subjects with HIV, that the use of emotional coping strategies was related to lower adherence to treatment. On the other hand, in the group of subjects with diabetes mellitus, the variable related to compliance with treatment was the duration of illness. Therefore, the predictive factors of adherence to treatment were different in each chronic pathology. In the group of subjects with diabetes mellitus, this variable was related to the duration of the disease. In the group of subjects with HIV, the type of coping strategy used predicted adherence to treatment. As a result of these results, it is possible to develop health programmes to promote, from nursing consultations to adherence to treatment of patients with HIV and diabetes mellitus.

Integrative literature review of evidence-based guidelines on antiretroviral therapy adherence among adult persons living with HIV

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.

The role of health facility and individual level characteristics on medication adherence among PLHIV on second-line antiretroviral therapy in Northeast Ethiopia: use of multi-level model

BACKGROUND

Medication adherence plays a pivotal role in achieving the desired treatment outcomes. The proportion of HIV patients on second-line antiretroviral therapy is becoming a growing public health concern. However, to date, little attention has been given to second-line antiretroviral medication adherence. Moreover, the association between health facility characteristics and medication adherence has yet not been tested. Thus, this research was conducted to determine the magnitude of medication adherence and examine the role of facility-level determinants among HIV patients on second-line ART.

METHODS

A cross-sectional study was conducted on 714 HIV patients on second-line therapy who were selected via systematic random sampling in twenty public health facilities. Medication adherence was measured using the six-item Simplified Medication Adherence Questionnaire (SMAQ) tool. Data were collected in a personal interview as well as document reviews. A multi-level binary logistic regression was used to uncover individual and facility-level determinants. The effect size was presented using an adjusted odds ratio (AOR), and statistical significance was declared at a P value less than 0.05.

RESULTS

The magnitude of optimal medication adherence among HIV patients on second-line antiretroviral therapy was 69.5% (65.9-72.7%). Medication adherence was positively associated with the use of adherence reminder methods [AOR = 3.37, (95% CI 2.03-5.62)], having social support [AOR = 1.11, (95% CI 1.02-1.23)], and not having clinical depression [AOR = 3.19, (95% CI 1.93-5.27). The number of adherence counselors [AOR = 1.20, (95% CI 1.04-1.40)], teamwork for enhanced adherence support [AOR = 1.82, (95% CI 1.01-3.42)], and caseloads at ART clinics were all significantly correlated with ARV medication adherence at the facility level.

CONCLUSIONS

A large proportion of HIV patients on second-line antiretroviral therapy had adherence problems. Both facility-level and individual-level were linked with patient medication adherence. Thus, based on the identified factors, individual and system-level interventions should be targeted.

Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

Background: With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV (PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular.

Methods: Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis.

Results: Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention.

Conclusion: Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.

Determinants of first-line antiretroviral treatment failure among adult patients on treatment in Mettu Karl Specialized Hospital, South West Ethiopia; a case control study

Background

Antiretroviral therapy has dramatically reduced Human Immunodeficiency Virus related morbidity and mortality. It has also transformed HIV infection into a manageable chronic condition. However, first-line antiretroviral treatment failure continues to grow especially in resource limited settings. Despite this, determinants of first-line antiretroviral treatment failure are not well studied in Ethiopia.

Objective

To identify determinants of first-line antiretroviral treatment failure among adult patients on antiretroviral therapy in Mettu Karl Specialized Hospital, South West Ethiopia, in 2020.

Methods

A hospital based case-control study was conducted from October to November 2020. Simple random sampling technique was used to select participants. Interviewer administered questionnaire and record review were used for data collection. Data were entered into epi data version 3.1 and exported to SPSS version 20 for analysis. Bivariable and multivariable logistic regression analysis were used. At the end, variables with P-value < 0.05 at 95% confidence intervals for adjusted odds ratio were considered statistically significant determinants of first line treatment failure.

Result

A total of 113 cases and 339 controls were included in the study with response rate of 98.6%. Sixty-four (56.6%) of cases and 183 (54.0%) of controls were females. Baseline WHO clinical stage III and IV (AOR = 1.909, 95% CI: (1.103, 3.305), baseline body mass index<18.5kg/m²(AOR = 2.208,95% CI:(1.257,3.877),baseline CD4 cell count <100cells/mm³ (AOR = 3.016, 95% CI: (1.734, 5.246), having history of TB co-infection (AOR = 1.855, 95% CI: (1.027, 3.353), having history of lost to follow up (AOR = 3.235, 95% CI: (1.096, 9.551), poor adherence to medication (AOR = 7.597, 95% CI: (4.059, 14.219) and initiation of treatment after two years of diagnosis with HIV (AOR = 4.979, 95% CI: (2.039, 12.158) were determinants of first-line antiretroviral treatment failure.

Conclusion

In this study several variables were found to be determinants of first-line antiretroviral treatment failure. Concerned bodies should give more attention to early diagnosis of HIV, early enrollment in chronic HIV care and early initiation of ART before patients develop advanced WHO clinical stages. In addition, focus has to be given for patients with low CD4 count. Regular screening for TB, counseling on optimal adherence to medication and enhancing nutritional status of patients with low body mass index are also crucial to prevent first-line antiretroviral treatment failure.

Prevalence and correlates of comprehensive HIV/AIDS knowledge among adolescent girls and young women aged 15-24 years in Malawi: evidence from the 2015-16 Malawi demographic and health survey

Background

HIV epidemic remains a major public health issue in Malawi especially among adolescent girls and young women (AGYW). Comprehensive HIV/AIDS knowledge (defined as correct knowledge of two major ways of preventing the sexual transmission of HIV and rejection of three misconceptions about HIV) is a key component of preventing new HIV infections among AGYW. Therefore, the aim of this study was to identify the correlates of comprehensive HIV/AIDS knowledge among AGYW in Malawi.

Methods

The study was based on cross-sectional data from the 2015–2016 Malawi Demographic and Health Survey. It involved 10,422 AGYW aged 15–24 years. The outcome variable was comprehensive HIV/AIDS knowledge. Data were analysed using descriptive statistics, bivariate and multivariable logistic regression model. All the analyses were performed using complex sample analysis procedure of the Statistical Package for Social Sciences to account for complex survey design.

Results

Approximately 42.2% of the study participants had comprehensive HIV/AIDS knowledge. Around 28% of the participants did not know that using condoms consistently can reduce the risk of HIV and 25% of the participants believed that mosquitoes could transmit HIV. Multivariable logistic regression model demonstrated that having higher education (AOR = 2.97, 95% CI: 2.35–3.75), belonging to richest households (AOR = 1.24, 95% CI: 1.05–1.45), being from central region (AOR = 1.65, 95% CI:1.43–1.89), southern region (AOR = 1.65, 95% CI: 1.43–1.90),listening to radio at least once a week (AOR = 1.27, 95% CI: 1.15–1.40) and ever tested for HIV (AOR = 1.88, 95% CI: 1.68–2.09) were significantly correlated with comprehensive HIV/AIDS knowledge.

Conclusions

The findings indicate that comprehensive HIV/AIDS knowledge among AGYW in Malawi is low. Various social-demographic characteristics were significantly correlated with comprehensive HIV/AIDS knowledge in this study. These findings suggest that public health programmes designed to improve comprehensive HIV/AIDS knowledge in Malawi should focus on uneducated young women, those residing in northern region and from poor households. There is also a need to target AGYW who have never tested for HIV with voluntary counselling and testing services. This measure might both improve their comprehensive HIV/AIDS knowledge and awareness of their health status.

Antiretroviral Treatment Adherence and Determinant Factors Among Adult People Infected with Human Immunodeficiency Virus in Eastern Tigray General Hospitals, Northern Ethiopia, 2019

Background

Human immune deficiency virus is a significant cause of morbidity and mortality, especially in developing countries. Globally, about 37.9 million people had HIV/AIDS in 2018 and 36.2 million people were adults, Moreover, about 770,000 AIDS-related mortality occurred in adult infected people. Appropriate antiretroviral therapy adherence is important to minimize drug resistance, improve virological response, and decrease morbidity and mortality. Researches done in Ethiopia reported knowledge on antiretroviral therapy adherence and determinant factors were limited and the literature was scared. Moreover, the eastern zone of Tigray was inhabited with a highly rural population and this may be a significant facilitator and barrier to ART adherence. According to a census conducted by the central agency of Ethiopia in 2013, the eastern zone of Tigray has a population of 755,343, of whom 395,705 are women and 609,279 (80.66%) are rural inhabitants.

Objective

This study aimed to assess antiretroviral therapy adherence and determinant factors among Adult HIV infected people in eastern Tigray, 2019.

Methods

A cross-sectional study design was conducted from January 1 to June 30 2019 on 339 adults attending the antiretroviral clinic at eastern Tigray. A systematic random sampling method was used to pick the study samples. Data were collected by a structured questionnaire using face to face interview. P-value < 0.05 in multivariate analysis was used as a cut-point for the statistical significance of the association.

Results

About 74.6% of participants were adhering to antiretroviral therapy. Place of residence (AOR= 5.13 (1.63–13.44), social support (AOR=2.71 (1.37–9.74), HIV disclosure (AOR=3.32 (1.43–9.24), free from depression (AOR=2.54 (1.36–9.43) and free from substance use (AOR=3.42 (1.67–10.87) were the factors associated with adherence to antiretroviral therapy.

Conclusion and Recommendation

Drug adherence in eastern Tigray was low and place of residence, social support, HIV disclosure, free from depression and free substance use were the factors associated with ART. So, awareness creation for rural residence, social support, avoidance of depression, and substance use should be strengthened to increase drug adherence.