Adherence to antiretroviral therapy among HIV-infected subjects in aresource - limited setting in the Niger Delta of Nigeria

Abstract

Since the early days of antiretroviral therapy, adherence has emerged a milestone to success. The objective of this study was to evaluate the factors militating against adherence to antiretroviral therapy among HIV-infected individuals in the resourcelimited setting of the Niger Delta of Nigeria. A structured interviewer-administered questionnaire from consecutively recruited 187 HIV-infected patients on combination antiretroviral therapy of two-nucleoside analogue; stavudine and lamivudine and one non-nucleoside (nevirapine) was used. Association between the independent variables and adherence were analyzed using chi square analysis. This study observed an adherence level of 49.2% and identified the following as factors associated with nonadherence: cost of antiretrovirals, educational status, medication adverse effect, occupational factors, and high pill burden of prescribed regimen (p < 0.05). There is an urgent need for universal access and sustainability of antiretroviral therapy particularly in resource-limited settings. There is need for supervised medication delivery. Efforts should be made towards simplifying the therapeutic regimen to reduce the pill burden and substitution with treatment combination and strategies that minimize negative adverse effects, coupled with the re-intensification of patient's education and counseling.

Comparison of Viral Load and CD4+ Values of ARV Naïve and ARV Challenged HIV Patients in Taraba State Nigeria

“…Reason could be attributed to the fact that these age groups are in their youth, hence are more sexually active and prone to unprotected sexual intercourse, drug abuse and acts associated with youthful exuberance. This finding is consistent with that of Nwauche et al [31] who had a mean age of 35.04 years in Port Harcourt and similar to that of Omoti et al [24]; Nwanzor and Nwankwo [7]; and Martinson et al [32].…”

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“…Therefore, the reported results of this study and those of the other mentioned studies are suboptimal. Lower rates among the general HIVpatient population have been reported in Nigeria: 62.6% 16 , 58% 17 , 44% 23 , 49.2% 35 and 62.5% 18 in Ibadan, Benin, Ilesha, Niger Delta region and North Central region respectively. These differences are still not absolute measures of comparison since adherence is defined in different ways and is measured using different tools.…”

Challenges Associated with the Effective Management of HIV Infection in a Low Income Setting in Sub Saharan Africa: Case Study of Nigeria

“…Low adherence has been associated with detectable viral load (>500 viral RNA copies/ml of plasma (Ruthbun et al, 2005) and possible cross resistance to other antiretrovirals of the same class (Tchetgen et al, 2001). A previous study (Nwauche et al, 2006) to evaluate the factors militating against adherence to antiretroviral therapy among 187 HIV-infected persons on a combination therapy of two-nucleoside analogue; stavudine and lamivudine and one non-nucleoside nevirapine in the Niger Delta of Nigeria indicated an adherence rate of 49.2%.Factors associated with non-adherence included; cost of antiretrovirals, educational status of subjects, medication adverse effects, occupational factors and high pill burden of prescribed regimen. There is need for universal access to antiretroviral treatment .Cost constraint remains a major limiting factor on adherence particularly in resource-limited settings (Muko et al, 2004).…”

“…HIV infection is endemic in Nigeria and is an important cause of infant mortality and morbidity. A previous study (Akani et al,2006) was undertaken to determine the sero-epidemiology of HIV among One hundred and forty (n = 140) consecutively recruited abandoned babies with mean age of 11.5 ± 24.1 weeks made up to 79 males and 61 females. The babies were referred to the HIV screening unit from motherless baby's homes in Port Harcourt for pre-adoption HIV screening within a five years period (1999 -2003 (89.5%).…”

“…A considerable body of evidence has associated the act of disclosing personal trauma-related information with improved physiological health and that it can lead to support that facilitates initiation of and adherence to treatment (Chandra et al, 2003, Klitzman et al,2004.The dilemma of choosing to disclose personal information is somewhat of a cruel paradox (Harber, 1992 ).Often people long to share a trauma or secret with another, yet they fear the possible rejection or alienation by the listener (Silver et al, 1990). A previous study (Akani et al, 2006) in the Niger Delta of Nigeria evaluated the rate, patterns and barriers to HIV serostatus disclosure. A pre-tested interviewer-administered questionnaire from 187 HIV infected people residing in a resource-limited setting in the Niger Delta of Nigeria was analysed.…”