Adherence to antiretroviral therapy and its determinants among persons living with HIV/AIDS in Bayelsa state, Nigeria

Background:

A high level of adherence is required to achieve the desired outcomes of antiretroviral therapy. There is paucity of information about adherence to combined antiretroviral therapy in Bayelsa State of southern Nigeria.

Objectives:

The objectives of the study were to determine the level of adherence to combined antiretroviral therapy among the patients, evaluate the improvement in their immune status and identify reasons for sub-optimal adherence to therapy.

Methods:

The cross-sectional study involved administration of an adapted and pretested questionnaire to 601 consented patients attending the two tertiary health institutions in Bayesla State,

Nigeria:

The Federal Medical Centre, Yenagoa and the Niger-Delta University Teaching Hospital Okolobiri. The tool was divided into various sections such as socio-demographic data, HIV knowledge and adherence to combined antiretroviral therapy. Information on the patient’s CD4+ T cells count was retrieved from their medical records. Adherence was assessed by asking patients to recall their intake of prescribed doses in the last fourteen days and subjects who had 95-100% of the prescribed antiretroviral drugs were considered adherent.

Results:

Three hundred and forty eight (57.9%) of the subjects were females and 253 (42.1%) were males. The majority of them, 557 (92.7%) have good knowledge of HIV and combined anti-retroviral therapy with a score of 70.0% and above. A larger proportion of the respondents, 441 (73.4%), had ≥95% adherence. Some of the most important reasons giving for missing doses include, “simply forgot” 147 (24.5%), and “wanted to avoid the side-effects of drugs” 33(5.5%). There were remarkable improvements in the immune status of the subjects with an increment in the proportion of the subjects with CD4+ T cells count of greater than 350 cells/mm3 from 33 (5.5%) at therapy initiation to 338 (56.3%) at study period (p<0.0001).

Conclusion:

The adherence level of 73.4% was low which calls for intervention and improvement. The combined antiretroviral therapy has significantly improved the immune status of the majority of patients which must be sustained. “Simply forgot” was the most important reason for missing doses.

Prevalence and control of hypertension in a Niger Delta semi urban community, Nigeria

BACKGROUND

Hypertension is a public health problem worldwide, but the prevalence in Amassoma, Southern Ijaw Local Government Area is not known.

OBJECTIVE

To investigate the prevalence of hypertension in the locality and the extent of control in diagnosed cases.

METHODS

It is a prospective study involving interviewing. Four hundred adults aged 20 years and above selected through stratified random sampling across the various compounds called "AMA"; a unit of settlement comprising extended families of common ancestors. A self-developed, validated and pretested interviewer-administered questionnaire on demographics, predisposing factors, and medication history was used. In addition, measurement of respondents' blood pressure, weight and height was carried out. The Body Mass Index calculated and the data were appropriately analysed.

RESULTS

The response rate of questionnaire distribution was 100.0% being interviewer administered alongside weight, height and blood pressure measurement. Majority of respondents were female. Almost half of respondents (46.5%) had their BMI above normal, 15.3% (61) of which falls within the obese region (>30.0kg/m2). The mean (SD) systolic blood pressure among males was 133.3 (3.2) mmHg and that of females was 127.4 (3.0) while the mean (SD) diastolic blood pressures were 86.2 (1.7) and 83.9 (2.4) for males and females respectively. Crude prevalence rate of hypertension in the community was 15.0% (60) out of which 13.8 % (55) were previously diagnosed. The hypertension was that of Stage I in 11.5% (46) and Stage II in 3.5% (14). Hypertension prevalence was slightly higher in males (18.8%) than that of the females (12.5%) (p= 0.0889), Relative Risk (RR)=1.500 [95%CI 0.9422:2.388]. The prevalence rate among 40 years and above was 41.6% (42/101) who also constituted 70.0% (42/60) of participants with hypertension in the survey and 10.5% (42/400) of the total. Of the previously diagnosed cases of hypertension, only 31% (17/55) were taking their drugs during the survey and only 12.7% (07/55) had regular adherence to medication and adequate BP control was achieved in 7.3% (04/55). Majority of the patients on drugs (21.8%) (12/55) were either taking methydopa as monotherapy or in combination with amiloride and hydrochlorothiazide. Other drugs being taken by patients include lisinopril, propranolol, amlodipine, atenolol, nifedipine and low dose aspirin.

CONCLUSIONS

The prevalence of hypertension in the semi urban community is 15.0% with a pre-hypertension in another 23.5%. There was poor control of blood pressure among previously hypertensive patients.

Evaluation of the cost of therapy for the treatment of sexually transmitted infections in a Nigerian teaching hospital

Objective

To determine the cost of therapy to patients of sexually transmitted infections in a Nigerian teaching hospital.

Methods

A retrospective drug-utilization evaluation in conjunction with cost-of-illness analysis was used. Two hundred and twenty seven case notes containing 310 prescriptions of patients with sexually transmitted infections were examined over a 1-year period between 2005 and 2006. Relevant data including demographics, diagnosis, prescribed drugs and dosages were extracted and the associated costs, direct and indirect, were evaluated.

Key findings

Disease occurrence was higher among the most productive work force group of 21–40 years (59.0%), which had 82.0% of the prescriptions. The overall average cost of antibacterial agents for sexually transmitted infection per patient (n = 227) was NGN977.85 (US$7.52) while the overall average cost per prescription (n = 310) was NGN716.04 ($5.51). The highest average cost of antibacterial agents of NGN2028.00 ($15.60) was obtained for chlamydial infection. The overall average of cost of therapy per patient (n = 227) was NGN2610.65 ($20.08). Chlamydial infection had the highest overall average cost of therapy, at NGN5408.92 ($41.60). The discounted average total cost of therapy for the year 2010 was $48.23 for chlamydial infection. Antibacterial agents constituted the highest cost component (37.5%) followed by indirect costs (26.5%). The average cost of therapy per patient of NGN2610.65 ($20.04) gave a 2010 discounted value of $23.23.

Conclusion

The cost of therapy for these infections to patients and the nation as a whole is huge.

Drug compliance among hypertensive patients in Kassala, eastern Sudan

A cross-sectional study of hypertensive patients was conducted and drug compliance was estimated. Factors associated with compliance, status of blood pressure control and occurrence of complications were assessed. Compliance was 59.6% as measured with the pill count method. We found 92% of compliant patients had controlled blood pressure in comparison with 18% of non-compliant patients, and 30.1% of the compliant patients had complications in comparison with 46.3% of the non-compliant patients. While the compliance rate was reasonable, 36.8% of patients were non-compliant because they could not afford to buy antihypertensive drugs. Inability to buy drugs was negatively and significantly associated with compliance. These patients experienced uncontrolled blood pressure and other complications.