Effects of Psychosocial Parameters on Adherence of Adult Nigerians to Antiretroviral Therapy

Abstract

Background: Combination antiretroviral therapy (ART) is the cornerstone of management of patients with HIV infection but requires a high level of adherence in order to achieve viral suppression.Psychosocial factors may affect adherence. Aim: To determine the rate of adherence of adult HIV seropositive adult Nigerian to antiretroviral therapy and the effects of psychosocial factors including psychiatric morbidity, patients’ perception of their illness, availability of social support, preference for alternative  medicine on adherence to antiretroviral therapy. Methods: A cross sectional descriptive study was carried out with 192 patients recruited from among patients attending the HIV/AIDS clinics at the University of Port Harcourt Teaching Hospital (UPTH) and the Braithwaite Memorial Hospital (BMH), Port Harcourt, Nigeria. All recruited patients were administered a pre-tested structured questionnaire made up of fifty mainly close ended questions on demographic parameters, knowledge and attitude to HIV/AIDS, antiretroviral medication, general health, psychological adaptation to their illness and social support accessible to the patients. A depressive symptom was also assessed with the twelve item GHQ-12. Results: A total of 192 patients were recruited, out of which 187 responded fully to the administered questionnaire. Adherence rate to antiretroviral (ARV) therapy (that is patient who took 95% or more of the prescribed antiretroviral drugs in the previous month) was 72.2%. Reasons proffered forgetfulness(24.6%), no pills at dosing time(21.4%), feeling uncomfortable after taking medication(15.1%), trying to save money(10.3%), too many medications(6.3%) and others (22.3%). Factors associated with poor ARV therapy adherence were depression and preference for alternative medical approach like herbal medications. Patients who had poor knowledge of HIV/AIDS and its treatment, poor social support and self perception of health status as being poor had lower adherence rates. There was no statistically significant association between sociodemographic characteristics such as age, sex, level of education and adherence to ARV therapy among patients (p>0.05). Conclusion: The level of adherence to antiretroviral medication among this cohort of patients is poor. Presence of depressive symptoms and preference for alternative non-orthodox therapy are associated with poor antiretroviral therapy adherence. Preference for alternative medicine in search of a permanent cure is high among these patients. Key Words: HIV/AIDS, adherence, antiretroviral therapy, adult Nigerians.