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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.
Study area and setting: the study was conducted in Cross River State located in the southern part of Nigeria [18], with Calabar as its capital city [19]. The State shares boundaries with Akwa Ibom State to the South-West, Ebonyi and Abia to the West, Benue to the North, the Republic of Cameroon to the East and the Atlantic Ocean to the West. Cross River has 18 LGAs, with an estimated population of 3,674,951 (2015 estimate), projected from the 2006 census population at a growth rate of 2.9% [19]. The State is composed of several ethnic groups, which include the Efik, Ejagham, Yakurr, Bahumono, Bette, Yala, Igede, Ukelle, Utukwang and the Bekwarra [19]. The prevalence of HIV in the State dropped from 6.6% in 2014 to 1.7% in 2018 [20,21]. Cross River State, sandwiched between Benue and Akwa Ibom States, the two States with the highest prevalence of HIV in Nigeria, is a choice tourist destination with a large influx of visitors [6]. The four study facilities provide comprehensive HIV care (paediatric, adult and prevention of maternal to child transmission of HIV services) and run clinics from Monday through Friday. University of Calabar Teaching Hospital, the only tertiary healthcare facility in the State, has 5,800 patients accessing HIV care, of which more than 3,900 were on HAART; while General Hospital Calabar, had 11,057 patients with 3,294 on HAART. Study design: a cross-sectional facility-based descriptive study. Study population: we studied 999 adult (≥18 years) HIV-infected patients receiving treatment in three general hospitals (one from each senatorial district) and the only teaching hospital in the State. Eligibility criteria: all the adult patients on HAART for at least three months prior to the study were eligible to participate. People living with HIV/AIDS (PLWHA) who were too sick, pregnant, had cognitive impairment or other disabilities like deafness, were excluded from the study. Sample size determination: using the Leslie Kish formula for determination of minimum sample size based on the assumption of ART adherence rate of 59.9% among adult HIV-infected patients from a similar study [16], 5% precision, design effect of 2.4 and adjusting for a non-response rate of 10% non-response, the desired sample size was determined to be 985 rounded to 999 participants. This sample size was proportionately allocated to the study facilities. Sampling technique: a multi-stage sampling involving three-stage was used to select participants for the study. The first stage involved selection of one local government area (LGA) each from the three senatorial districts in the State through simple random sampling (SRS). In the second stage (selection of study facilities), one general hospital was selected by SRS from each of the three selected LGA, while the only teaching hospital in the State was also included, giving a total of four selected facilities (General Hospital Calabar, General Hospital Ugep and General Hospital Obanliku representing the south, central and northern senatorial districts respectively, with University of Calabar Teaching Hospital included as the only teaching hospital in the State). Systematic random sampling was used in the third stage to recruit participants from the selected facilities based on proportionate allocation of sample size to each facility. Study instruments: a pre-tested, semi-structured, interviewer-administered questionnaire adapted from a similar study [16] was used to collect information on participants´ socio-demographic characteristics, treatment history (when treatment commenced, type of HAART regimen), adherence profile and attitude to HAART. Quantitative survey: collected data uploaded to a secure server were exported in Microsoft Excel XLS format, cleaned in Excel spreadsheet and analysed with SPSS version 23. Frequencies, percentages, mean and standard deviations were used as appropriate in descriptive statistics. Adherence to HAART in the seven days preceding the interview was measured by self-report. The questions were adapted from brief medication questionnaire self-report tool for screening adherence and barriers to adherence [16]. The degree of adherence from patient self-report was estimated using the following formula [22]. For the purpose of the study, adherence score of 95% and above represented good adherence while scores of less than 95% were rated as poor adherence. At bivariate analysis, association between HAART adherence and independent variables such as socio-demographic and treatment characteristics were determined using Chi-square tests with corresponding p-values. Variables that had a p-value of ≤ 0.2 at bivariate analysis were entered into the logistic regression model to determine the predictors of HAART adherence. The results of the logistic regression were reported using odds ratios and 95% confidence intervals. All statistical analyses were performed at 5% level of significance. Ethical considerations: ethical approval for this study was obtained from the Health Research Ethics Committees of University of Calabar Teaching Hospital (reference: UCTH/HREC/33/519) and the State Ministry of Health (reference: RP/REC/2016/422). Written informed consents were obtained from the participants after the details of the study and its voluntariness was explained to them. Safety and confidentiality of collected data was ensured throughout the study.
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