Factors influencing adherence to antiretroviral therapy among HIV-infected adults in Cross River State, Nigeria: a cross-sectional study

Impact of differentiated care service delivery systems on adherence among the HIV-positive patients receiving antiretroviral therapy in a Southeastern Nigerian State

AIM

Globally, differentiated care has been adopted across human immunodeficiency virus (HIV) treatment cascades as part of the strategies of increasing and sustaining retention in care. This study examined the impact of this new service delivery approach on adherence among patients receiving antiretroviral therapy in Imo state, Nigeria.

METHODS

This was a cross sectional study carried at one tertiary and three secondary care hospitals selected across the state using a questionnaire. The study examined patients in three differentiated care models, and the usual care group. Collated data were analysed using the statistical product and service solutions (SPSS) version 24, at p ≤ 0.05 and 95% confidence level.

RESULTS

A total of 542 questionnaires were successfully retrieved from the respondents. The female gender was predominant in all the groups, accounting for total average of 70.8%. The percentage of respondents with optimum adherence score (≥ 96.6%) for multi-months scripting, fast track, support group, and usual care groups were 70.6,69, 97.4, 59.1 respectively. Of all the groups, the support group had the highest adherence to ART. Forgetfulness, traveling, avoidance of side effects, and feeling sick topped the reasons adduced for missing drugs. Age, place of residence, occupation and engagement of voluntary activities were socio-demographics influencing adherence. Adherence had significant association with the viral load suppression (Odds ratio = 3.147, p < 0.05, 95% C.I 2.025-4.891).

CONCLUSION

The study demonstrated that the adoption of differentiated care has enhanced patients' adherence to ART which differed across the models. There is need for continual counseling and support to the patients by healthcare providers so as to further improve adherence.

The Impact of Place of Residence on Antiretroviral Therapy Adherence: A Systematic Review and Meta-Analysis

Objective: There is evidence of geographical variation in HIV coverage and antiretroviral therapy (ART) adherence, and studies have investigated how the place of residence of people living with HIV (PLWH) influences ART adherence. Where people reside influences their access to health care. Studies on the influence of place of residence on ART adherence among PLWH in Nigeria have been reported in the literature. However, no review has synthesized these findings. Against this backdrop, this review seeks to determine whether adherence to ART differs by place of residence in Nigeria. Methods: In May 2024, we searched four databases (CINAHL Plus, PubMed, Scopus, and Web of Science). Only empirical studies with a test of association between place of residence (i.e., urban and rural) and adherence to ART were included. We performed a fixed-effect meta-analysis with the meta package on R Studio Version 4.2.0. Results: We included six of the 91 articles across the four databases. Most studies (n = 5) were conducted in the Southern region. The assessment of place of residence and adherence varies across the studies. We found that PLWH who reside in urban areas were 20% more likely to adhere to ART compared to those who live in rural areas (odds ratio: 1.20; 95% confidence interval: 1.01-1.43). Similarly, PLWH in the South-South region of Nigeria and reside in the urban areas were 1.27 (95% CI: 1.01-1.58) more likely to adhere to ART than those living in the rural areas. This observation was insignificantly true for the South-East region. Conclusion: PLWH who reside in urban areas may better adhere to ART than their counterparts living in rural areas. Non-governmental organizations and government agencies working with PLWH should prioritize those living in rural areas because they are more likely to face greater barriers to adherence.

Gender differences in symptom burden among people living with HIV/AIDS receiving antiretroviral therapy in Yunnan, China

ABSTRACTLittle is known about gender differences in the symptom burden of people living with HIV/AIDS (PLWHA) on antiretroviral therapy in China. This study was conducted based on a biopsychosocial-medical model to describe gender differences in symptom burden among 1035 PLWHA in Yunnan Province, China. After propensity score matching, 798 PLWHA were included in this analysis. Feeling stressed, poor sleep, and memory loss were the most burdensome symptoms among men, while feeling stressed, memory loss, and dizziness were the most burdensome symptoms among women. Among men PLWHA, factors associated with symptom burden were being of the ethnic minority, CD4 count ≥ 500 cells/mm3, physical functioning, and social support. Among women PLWHA, factors associated with symptom burden were being an inpatient, physical functioning, psychological functioning, and social support. Our findings suggest that healthcare providers need to take into account gender differences when developing optimal prevention, treatment, and care programs that provide individualized care to reduce patients' symptom burden.

Adherence determination using urine-tenofovir point-of-care testing and pharmacy refill records: A cross-sectional study

Pharmacy refill records (PRR), are an accessible strategy for estimating adherence in low- and middle-income countries (LMICs). However, the low-cost urine-tenofovir point-of-care test opens up the possibility of an objective metric of adherence that is scalable to LMICs. This study compared adherence to tenofovir-based regimens using urine-tenofovir point-of-care (POC) test with pharmacy refill records in a Nigerian population of HIV-positive persons. This was a cross-sectional study among 94 HIV-positive adults, which was conducted from June to August 2021, in a large outpatient clinic in Lagos, Nigeria. Adherence to pharmacy appointments was automatically calculated using a computerized pharmacy appointment system (FileMaker Pro™). Urine drops on the urine-tenofovir POC test strip developed 2 lines for a negative test (tenofovir absent) and one line for a positive test. Fisher's exact test was used to examine the association between pharmacy refill record and urine-tenofovir point-of-care test. Logistic regression was performed to predict viral suppression (<1000 copies/mL, based on WHO recommendations) using both methods of adherence determination. A Receiver Operating Characteristic (ROC) curve of the association between specificity and sensitivity was generated to evaluate the predictive value of adherence determined using pharmacy-refill record and urine-tenofovir point-of-care test in forecasting viral suppression. The statistical significance level was set at 0.05. Fisher's exact test showed no statistically significant difference in adherence using urine-tenofovir point-of-care test or pharmacy refill record. The logistic regression model showed that an increase in pharmacy-refill record of ≥ 95% was associated with viral suppression (P = .019). From the ROC curve, the sensitivity was same at 95.5% for both methods, but the specificity of the urine-tenofovir point-of-care test was greater (96.6% vs 95.5%) than pharmacy refill record (P = .837). Urine-tenofovir point-of-care test provided equivalent adherence data to pharmacy refill data.