Retention in care and adherence to HIV and AIDS treatment in Anambra State Nigeria

Abstract

Background Retaining patients on antiretroviral treatment in care is critical to sustaining the 90:90:90 vision. Nigeria has made some progress in placing HIV-positive patients on treatment. In an effort to increase access to treatment, ART decentralization has been implemented in the country. This is aimed at strengthening lower level health facilities to provide comprehensive antiretroviral treatment. We determined the level of retention and adherence to treatment as well as the associated factors among private and public secondary level hospitals in Anambra State. Method We conducted a cross-sectional study among patients who had taken antiretroviral treatment for at least one complete year. A structured questionnaire and patient record review were used to extract information on patient adherence to treatment, and retention in care. Adherence to treatment was ascertained by patient self-report of missed pills in the 30 days prior to date of interview. Retention in care was ascertained using the 3-month visit constancy method reviewing the period spanning 12 months prior to the study. Result We found a comparable level of retention in care (private 81.1%; public 80.3%; p = 0.722). However, treatment adherence was significantly higher amongst participants in the private hospitals compared to those in the public hospitals (private: 95.3%; public: 90.7%; p = 0.001). Determinants of good retention in the private hospitals included disclosure of one’s HIV status (AOR: 1.94, 95% CI: 1.09–3.46), being on first-line regimen (AOR: 3.07, 95% CI: 1.27–7.41), whereas being on once-daily regimen (AOR: 0.58, 95% CI: 0.36–0.92), and being currently married (AOR: 0.54 95% CI: 0.32–0.91) determined poor retention. In the public hospitals, only disclosure (AOR: 3.12 95% CI: 1.81–5.56) determined good retention, whereas, spending less than N1000 on transport (AOR: 0.230 95% CI: 0.07–0.78) and residing in a rural area (AOR: 0.64 95% CI: 0.41–0.99) determined poor retention. None of the factors determined adherence. Conclusion Retention in care was high and comparable among the different hospital types and HIV disclosure status was an important factor relating to retention in care. The other factors that determined retention were however different at public and private hospitals. The HIV program manager should consider these variations in designing programs to improve patient retention in care and adherence to treatment.

Retention in HIV Care and Associated Factors Among Youths Aged 15-24 Years in Rural Southwestern Uganda

“…Marital status for both men and women was signi cantly associated with retention in HIV care in our study. Our ndings are similar to those reported by Umeokonkwo et al (2019) in Anambra state in Nigeria in which marital status was a signi cant predictor of retention (30). Being married, or having a spouse provides a source of psychological and emotional support which improves retention in care compared to those who are single and not in a relationship.…”

<p>Differential Self-Reported Determinants to Antiretroviral Therapy Adherence: Findings from Caregivers of Children Under Five Years Living with Human Immunodeficiency Virus Infection Attending Al-Sabah Hospital, South Sudan</p>

“…26,27 Additional factors showed that the kind of attention the healthcare provider offered, improved quality of HIV services, and the use of western medicine were pivotal to ART adherence. This was critical as the use of "alternative HIV treatment options" mainly traditional concoctions, holy water, as well as prayers as a cure for HIV had been reported from previous studies; [27][28][29][30]31 and such beliefs showed the growing demand for improved healthcare services, as well as addressing societal and culture barriers of ART. While the findings of this study are valid, they ought to be interpreted with caution due to the following limitations: a) the study was only limited to Al-Sabah Children's Hospital and cannot be generalizable to other health facility, b) also a small sample size of 126 caregiver-child pair was used, c) the use of caregiver self-report may have overrated ART adherence due to recall bias as well as attempt to impress the interviewer and healthcare providers, d) ART adherence was assessed based on missed doses with no regard of correct timing of medication, e) caregiver self-reported adherence relied on their giving rightful information, f) the reported past 7 days of ART adherence was a short time and may not have correlated well with annual adherence levels, and g) the study only used interview data.…”

Effect of a multi-dimensional case management model on anti-retroviral therapy-related outcomes among people living with human immunodeficiency virus in Beijing, China

“…The total adherence was measured by average all the adherence percentage of every follow-up. Participants with≥95% adherence were classified as having "good adherence" while those that took below 95% of their ART were classified as having poor adherence [22].…”