Challenges to adherence among HIV-positive patients on antiretroviral therapy in Lagos, Nigeria

Purpose of the study

Adherence is a key issue in HIV/AIDS treatment and care programs. It is important to identify factors that affect adherence as it relates to survival, development of drug resistance, disease progression, treatment outcome, and ability to stay on first-line therapy in resource-poor settings with limited treatment options and expertise for management.

Methods

384 patients were evaluated with the aid of questionnaires in 2007, with 320 receiving antiretroviral therapy from government hospital and 64 from private clinics in Lagos. Adherence was by self-report of missing pills. The primary outcome of interest was ≥95% adherence. Logistic regression was used to model factors affecting adherence.

Summary of results

Mean age: 30.5 years; female: 62%. ≥95% adherence was associated with partner notification, OR = 0.6 (p < 0.001); side-effects, OR 1.3 (p = 0.02). 58% were on efavirenz-containing regimen and 42% on nevirapine. Participants taking efavirenz were more likely to have ≥95% adherence than nevirapine-based drugs (40.4% vs. 28.6%, p = 0.017). Multivariate analysis showed that partner notification (OR 0.7 [95% CI 0.4–0.8], reduction in number of pills taken (OR = 0.6 [95% CI 0.3–0.8), and side-effects (OR 1.7 [95% CI 1.2–2.3] and female (OR 1.2 [95% CI 1.1–1.6] were associated with adherence. 92% preferred reduction in number of pills taken per day by using combined formulation. 42% attributed stigma as a challenge to adherence, while 22% reported fear of the drugs, 20% financial constraint (especially those receiving medication in private practice), and 18% due to transportation cost to the treatment facility.

Conclusion

Adherence support, motivation and skills are needed to sustain our treatment program against virologic and immunologic failures. Proactive ways of supporting adherence programs are needed. Additionally, reminder tools may be needed. It is important to re-enforce partner/family notification and reduce stigma towards better adherence. Emphasis should be on the use of combined HIV drug formulation to reduce daily number of pills taken.