Level of non-adherence and its associated factors among adults on first-line antiretroviral therapy in Amhara Regional State, Ethiopia

Non-Adherence to Anti-Retroviral Therapy Among Adult People Living with HIV in Ethiopia: Systematic Review and Meta-Analysis

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.

Factors influencing adherence to antiretroviral therapy among HIV-infected adults in Cross River State, Nigeria: a cross-sectional study

Introduction

improved access to antiretroviral therapy (ART) has significantly increased the survival and quality of life of HIV-infected persons. Strict adherence to antiretroviral therapy (ART) is crucial if viral suppression must remain optimal. We assessed predictors of adherence to ART among adult patients in Cross River State (CRS), Nigeria.

Methods

a cross-sectional survey was conducted among 999 adult patients on ART in selected secondary and tertiary health facilities in CRS from January to June 2017. Respondents were recruited using multistage technique. Data were collected using a pre-tested interviewer-administered questionnaire. Adherence was defined as clients taking at least 95% of their pills in the last seven days. Multivariate analysis was performed to determine predictors of adherence at 5% level of significance.

Results

majority (70.5%) of the respondents were females with a mean age of 43.7 ± 11.1 years. The self-reported adherence rate was 60.1%. The commonest reasons for non-adherence was client travelling out of home, being busy, forgetting and lack of food. The significant predictor identified in this study was being on first-line drugs (OR=3.677, 95% C.I=2.523-5.358), were 3 times more likely to have good adherence. Predictors of poor-adherence were alcohol intake (OR=0.382, 95% C.I=0.262-0.559), dosing medications (OR=0.502, 95% C.I=0.381-0.661), CD4 cell count ≥ 500 (OR=0.723, 95% C.I=0.543-0.964), poor attitude to HIV status and medication (OR=0.713, 95% C.I=0.512-0.994) and family support (OR=0.736, 95% C.I=0.544-0.995).

Conclusion

adherence to ART among clients in this study was fair. Majority of the reasons for poor-adherence were client-related. There is need for targeted counselling to improve adherence.