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Background: Adherence to Highly active antiretroviral therapy (HAART) is a major predictor of the success of HIV/AIDS treatment. Good adherence to HAART is necessary to achieve the best virologic response, lower the risk of drug resistance and reduce morbidity and mortality. This study therefore aimed to determine the prevalence and determinants of adherence to HAART amongst PLHIV accessing treatment in a tertiary location in Cross River State, Nigeria. Methods: A cross-sectional study was conducted among patients on HAART attending the Presidential Emergency plan for AIDS relief (PEPFAR) clinic of the University of Calabar Teaching Hospital between October-December 2011. A total of 411 PLHIV visiting the study site during the study period were interviewed. PLHIV who met the inclusion criteria were consecutively recruited into the study till the desired sample size was attained. Information was obtained from participants using a semi-structured, pretested, interviewer administered questionnaire. Adherence was measured via patients self report and were termed adherent if they took at least 95% of prescribed medication in the previous week prior to the study. Data were summarized using proportions, and χ2 test was used to explore associations between categorical variables. Predictors of adherence to HAART were determined by binary logistic regression. Level of significance was set at p < 0.05.Results: The mean age of PLHIV who accessed treatment was 35.7 ± 9.32 years. Females constituted 68.6% of all participants. The self reported adherence rate based on a one week recall prior to the study was 59.9%. The major reasons cited by respondents for skipping doses were operating a busy schedule, simply forgot medications, felt depressed, and travelling out of town. On logistic regression analysis, perceived improved health status [OR 3.11; CI: 1.58-6.11], reduced pill load [OR 1.25; 95% CI: 0.46-2.72] and non-use of herbal remedies [OR 1.83; 95% CI: 1.22-2.72] were the major predictors for adherence to HAART. However, payment for ART services significantly decreased the likelihood of adherence to HAART. [OR 0.46; 95% CI: 0.25-0.87.].Conclusions: The adherence rate reported in this study was quite low. Appropriate adherence enhancing intervention strategies targeted at reducing pill load and ensuring an uninterrupted access to free services regimen is strongly recommended. © 2013 Oku et al.; licensee BioMed Central Ltd.
The study was conducted at the President’s Emergency plan for AIDS Relief (PEPFAR) clinic now the Specialist treatment clinic of the University of Calabar Teaching Hospital. The Hospital was selected as a centre for the implementation of the President’s Emergency plan for AIDS Relief (PEPFAR) by the United States Agency for International Development (USAID) in June 2005. It has since been responsible for the provision of care and support services for PLHIV as well as one of the major centres where PLHIV both in Cross River and other neighbouring states receive anti retroviral therapy. The patient population is about 4,000, of which more than 2,000 are on treatment. The clinic is run under three units. The paediatric adult and the Prevention of Maternal to Child transmission (PMTCT) clinics. The study population comprised of 411 HIV positive clients who were enrolled and had commenced HAART in UCTH from October 2011- December 2011. They were made of 129 males and 282 females. Participants were consecutively recruited over the study period till the desired sample size was attained. All PLHIV on HAART were eligible to participate except those that satisfied the exclusion criteria. These criteria included PLHIV below 18 years of age, who were attending the clinic but had not commenced HAART, terminally ill patients and pregnant women. The inclusion criteria adopted for the study included consenting out patients diagnosed and confirmed to be HIV positive, at least 18 years of age and had been on HAART for 3 months. A cross-sectional analytical study aimed at documenting the level of adherence among PLHIV on HAART was conducted between October 2011- December 2011. This consisted of an interviewer administered semi-structured questionnaire which was divided into sections to collect relevant information on socio-demographic data, medical profile including treatment experiences at health facility of respondents. Adherence to HAART in the previous seven days of the interview was measured by self-report. The questions were adopted from The Brief Medication Questionnaire self-report tool for screening adherence and barriers to adherence [20]. The degree of adherence from patient self-reporting was estimated using the following formula: [21] Then, the percentage of adherence to the antiretroviral was estimated by the average of adherence to the drugs. For the purpose of this study a score of 95% and above represented good adherence and less than 95% was rated as having poor/suboptimal adherence. Data were analyzed using SPSS for windows version 19.0. Descriptive and inferential statistical tests were employed. These included bivariate (chi-square) and multivariate (logistic regression) analysis to determine correlates or predictors of adherence. Descriptive statistics (frequencies, proportions, means and standard deviation to summarize variables while Inferential statistics (chi square Test) was used to test the significance of association between categorical variables and level of significance was set at 5%. Logistic regression analysis was used to identify the predictors of adherence to HAART in the study population. Variables entered into the logistic model were those which had earlier been significantly associated on bivariate analysis at 10% significance derived. Predictors were determined at 5% significance. The ethical Committee of the University of Calabar Teaching Hospital reviewed and approved the study procedures and data collection instruments.
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