Title: Predictors of Adherence to Highly Active Antiretroviral Therapy among Key Populations Living with HIV/AIDS in Akwa Ibom State, South-South, Nigeria

Author: Edet, John Etim

 DOI: https://dx.doi.org/10.18535/jmscr/v12i10.01

Abstract

Key Populations are disproportionately affected and impacted by HIV/AIDS in all regions. Unfortunately, reaching Key Populations (KPs) with HIV intervention is a big challenge because of stigma, discrimination, deliberate government legislation against KPs, violence, and criminalization of KPs lifestyles. Because of the lack of KP specific interventions, data on KPs Highly Active Antiretroviral Therapy (HAART) outcomes is lacking. The study investigated Predictors of Adherence to HAART among Key Populations living with HIV/AIDS in Akwa Ibom State, South-South, Nigeria. A descriptive cross-sectional study was conducted using non-probability sampling technique.  Data were analyzed using descriptive statistics, Chi-square, and ANOVA. There were 330 study sample. The socio-demographic characteristics of the respondents showed that a total of 173 (52.42%) of the respondent were female while 157 (47.58%) were male. A total of 103 (31.21%), 106(3.12) and 62 (18.79) were within the age range of (18-30), (31-40) and (41-above) respectively. The mean age of participants was 28.39 years ± (with a range of 18-71). The overall self-reported adherence to HAART reported in this study was 71.9 %. Suboptimal adherence to HAART (≤ 95 %) was 74.5% among FSW, 71.8% among MSM, and 69.4 % among PWID.  The study reveals that the primary reasons for continuous uptake of HAART services from health facilities included availability of drugs, counselling support, availability of Case Managers, proximity to health facilities confidentiality, reduced waiting time and attitude of service providers. Perceived barriers to adherence most frequently reported by respondents were forgetting to take the medication, the volume of pills to be taken, side effects of the medication (nausea & vomiting) fear of stigma and religious beliefs were statistically significant (p=0.05). A well-coordinated care and follow up mechanism is required to achieve HAART adherence among the key populations. Therefore, intensifying health education and promotion alongside rescinding policies against of KPs would improve HAART adherence that will reduce further transmission of HIV and facilitate remarkable progress in achieving viral suppression.

References

  1. Adedini SA, Mobolaji JW, Alabi M, Fatusi AO. (2021). Changes in contraceptive and sexual behaviours among unmarried young people in Nigeria: Evidence from nationally representative surveys. PLoS             ONE 16(2), e0246309. doi: 10.1371/journal.pone.0246309
  1. Afe, A., Onyema, M., Ojoye, A., & Iwuoha, E. (2019). Analysis of HIV Treatment Cascade Among Key Affected Population in Lagos, Nigeria. European Journal of Medical and Health Sciences, 1(3), 57. doi: 10.24018/ejmed.2019.1.3.57
  2. Al-Hassany L, Kloosterboer SM, Dierckx B, Koch BCP (2019). Assessing methods of measuring medication      adherence in chronically ill children–a narrative review. Patient        Prefer Adherence. Dove Medical  Press, 2019(13), 1175-1189. doi:       2147/PPA.S200058
  3. Anghel LA, Farcas AM, Oprean RN. (2019). An overview of the common methods used to measure  treatment adherence. Med Pharm Rep., 92(2), 117-122. doi:10.15386/mpr- 1201
  4. Anyaike, Chukwuma, Oladele Ademola Atoyebi, Omotoso Ibrahim Musa, Oladimeji Akeem Bolarinwa & Kabir Adekunle Durowade. (2019). Adherence to combined       Antiretroviral therapy (cART) among             people living with HIV/AIDS in a     Tertiary            Hospital in Ilorin,        Pan African Medical Journal.          32(10), 7508.   doi: 10.11604/pamj.2019.32.10.7508. Retrieved from http://www.panafrican-medjournal.com/content/article/32/10/full/
  5. Awofala, Awoyemi Abayomi, Olusegun Emmanuel Ogundele. (2018). HIV epidemiology in Saudi J Biol Sci.  25(4): 697–703. doi: 10.1016/j.sjbs.2016.03.006
  6. Awolude, O. A., Olaniyi, O., Moradeyo, M., & Abiolu, J. (2021). Virologic Outcomes Following Enhanced Adherence Counselling among Treatment Experienced HIV Positive     Patients at University College Hospital, Ibadan, Nigeria. International STD      Research & Reviews, 10(1), 53-65. doi: 10.9734/ISRR/2021/v10i130126
  7. Avert (2020). Global HIV And AIDS Statistics Retrieved from Https://Www.Avert.Org/Global-            Hiv-And-Aids-Statistics
  8. Baral, S., Beyrer, C., Muessig, K., Poteat, T., Wirtz, A. L., Decker, M. R., ... & Kerrigan, D. (2012). Burden of HIV among female sex workers in low-income and middle-income countries: a systematic review and meta-analysis. The Lancet infectious diseases, 12(7), 538-549.
  9. Bärnighausen, T., Chaiyachati, K., Chimbindi, N., Peoples, A., Haberer, J., & Newell, M. L. (2011). Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies. The Lancet infectious diseases, 11(12), 942-951.
  10. Bond V, Nomsenge S, Mwamba M, Ziba D, Birch A, Mubekapi-Musadaidzwa C (2019). “Being seen” at the clinic: Zambian and South African health worker reflections on the     relationship between health facility place, space and HIV stigma in 21 health facilities, the HPTN 071 (PopART) study. Health Place,. 55, 87–99.        doi: 10.1016/j.healthplace.2018.11.006
  11. Bukenya, Dominic, Billy Nsubuga Mayanja, Sarah Nakamanya. (2019). What causes non- adherence among some    individuals on long term antiretroviral therapy?         Experiences of individuals with poor viral suppression in Uganda. AIDS            Research and Therapy. 16, 2. doi: 10.1186/s12981-018-0214-y
  12. Burke-Miller, J. K., Cook, J. A., Cohen, M. H., Hessol, N. A., Wilson, T. E., Richardson, J. L., ... & Gange, S. J. (2006). Longitudinal relationships between use of highly active antiretroviral therapy and satisfaction with care among women living with HIV/AIDS. American Journal of Public Health, 96(6), 1044-1051.
  13. Castillo-Mancilla JR & Haberer JE. (2018). Adherence measurements in HIV: new advancements in pharmacologic methods and real-time monitoring. Curr HIV/AIDS Rep., 15(1), 49–59
  14. Cedrina L. Calder, Heather O, Mohammad Tabatabai, Celia J. Maxwell, Salisha Marryshow, Aima Ahonkhai and  Muktar H. Aliyu (2020). Adherence to Combination            Antiretroviral Therapy among Pregnant Women Enrolled in a HIV Prevention Program in Rural    North-central Nigeria. Int J MCH AIDS.9(1),81-92. Doi.org/10.21106/ijma.327
  15. Cheng Y, Sauer B, Zhang Y, Nickman NA, Jamjian C, Stevens V & LaFleur J. (2018). Adherence andvirologic outcomes among treatment-naive veteran patients with human immunodeficiency virus type 1 infection. Medicine (Baltimore), 97(2), e9430. doi:10.1097/MD.0000000000009430
  16. Chersich, M. F., Luchters, S., Ntaganira, I., Gerbase, A., Lo, Y. R., Scorgie, F., & Steen, R. (2013). Priority interventions to reduce HIV transmission in sex work settings in sub‐Saharan Africa and delivery of these services. Journal of the International AIDS Society, 16(1), 17980.
  17. Chesney, M. A. (2000). Factors affecting adherence to antiretroviral therapy. Clinical Infectious Diseases, 30 (Supplement_2), S171-S176.
  18. Chesney, M. A., Ickovics, J. R., Chambers, D. B., Gifford, A. L., Neidig, J., Zwickl, B., ... & Patient Care Committee & Adherence Working Group of the Outcomes Committee of the Adult AIDS Clinical Trials Group (AACTG). (2000). Self-reported adherence to antiretroviral medications among participants in HIV clinical trials: the AACTG adherence instruments. AIDS care, 12(3), 255-266.
  19. Chijioke-Nwauche I. N & Akani Y (2021). Influencing Factors of Adherence to Antiretroviral Drugs among             People Living with HIV in South-South Nigeria. Saudi J Med Pharm          Sci,      7(2), 145-152.
  20. Chirambo, L., Valeta, M., Banda Kamanga, T.M. (2019). Factors influencing adherence to antiretroviral    treatment among adults accessing care from private health facilities             in Malawi. BMC Public    Health, 19, 13820. doi:10.1186/s12889-019- 7768-   z
  21. Chukwuedozie UP, Kalu UU, Chidi MS. (2019). Socio-Economic Effect of Commercial Sex Work in Abuja Suburb: A Survey of Selected Brothels in Mararaba, Nigeria. Social             and Crimonol 7, 2. doi:10.35248/2375-4435.19.7.200.
  22. Cruz CCP, Mistro S, Mendes CMC, Schooley RT, Badaró RJ da S. (2020). Monitoring of Delay to Pharmacy Refill in Assessing Adherence to Antiretroviral Therapy. Journal       of         Pharmacy Practice. 33(2), 158-163. doi: 10.1177/0897190018795339
  23. Damulak, P.P.; Ismail, S.; Abdul Manaf, R.; Mohd Said, S.; Agbaji, O. (2021). Interventions to Improve Adherence to Antiretroviral Therapy (ART) in Sub-Saharan Africa: An  Updated Systematic Review. Int. J. Environ. Res. Public Health, 18, 2477.  Doi:10.3390/            ijerph18052477
  24. Dandachi D, de Groot A, Rajabiun S, Rajashekara S, Davila JA, Quinn E and Giordano TP (2021). Reliability and Validity of a Brief Self-Report Adherence Measure among             People with HIV Experiencing Homelessness and Mental Health or substance use disorders. AIDS Behav 25(2):322-329. doi: 10.1007/s10461-020-02971-6
  25. Desta A, Biru TT, Kefale AT (2020) Health related quality of life of people receiving highly active antiretroviral therapy in Southwest Ethiopia. PLoS ONE, 15, 8, e0237013. Doi:             1371/journal.pone.0237013
  26. Deuba, Keshab, Diksha Sapkota, Upendra Shrestha, Rachana Shrestha & Bir Bahadur Rawal. (2020). Effectiveness of interventions for changing HIV related risk behaviours among      key populations in low-income setting: A Meta-Analysis, 2001–2016. Scientific      Reports 10(2197), s41598. Doi: 10.1038/s41598-020-58767-0
  27. Diabaté, S., Zannou, D. M., Geraldo, N., Chamberland, A., Akakpo, J., Ahouada, C., & Tremblay, C. (2011). Antiretroviral therapy among HIV-1 infected female sex workers in Benin: a comparative study with patients from the general population.
  28. THISDAYLIVE, Editor  (2020-08-14"A Gentle Reminder to the Leaders of Akwa Ibom State at              33rd     THISDAYLIVE. Retrieved 2021.
  29. Eggleton JS & Nagalli S. (2020). Highly Active Antiretroviral Therapy (HAART). Treasure Island (FL):    StatPearls        Publishing; 2021. Retrieved from             https://www.ncbi.nlm.nih.gov/books/NBK554533/
  30. Ekun, Oloruntoba Ayodele, Emmanuel Olusesan Fasela, David Ayoola Oladele, Gideon Odemakpore Liboro, Toyosi Yekeen Raheem. (2021). Risks of cardio-vascular    diseases           among highly active antiretroviral therapy (HAART) treated HIV seropositive volunteers           at a treatment centre in Lagos, Nigeria. Pan African Medical Journal. 38, 206.          doi: 10.11604/pamj.2021.38.206.26791
  31. Eluwa, G.I., Sylvia B. Adebajo, Titilope Eluwa, Obinna Ogbanufe, Oluwafunke Ilesanmi & Charles Nzelu.             (2019).  Rising HIV prevalence among men who have sex    with men in Nigeria: a trend   BMC Public Health 19, 1201. doi:     10.1186/s12889-019-7540-4
  32. Farouq Muhammad Dayyab, Fahad Mukhtar, Garba Iliyasu & Abdulrazaq Garba Habib (2021). Determinants of loss to follow-up among people living with HIV on antiretroviral therapy in Nigeria. African Journal of AIDS Research, 20, 1, 93-                 doi: 10.2989/16085906.2021.1874444
  33. Federal Ministry of Health N. (2010). Nigeria Integrated Biological and Behavioural Surveillance Survey (IBBSS).
  34. Feelemyer, J., Des Jarlais, D., Arasteh, K., & Uusküla, A. (2015). Adherence to antiretroviral medications among persons who inject drugs in transitional, low and middle income countries: an international systematic review. AIDS and Behavior, 19(4), 575-583.
  35. Fisher, J. D., Fisher, W. A., Amico, K. R., & Harman, J. J. (2006). An information-motivation-behavioral skills model of adherence to antiretroviral therapy. Health Psychology, 25(4), 462
  36. Gaifer Z, Boulassel M-R. (2019). Comparative Analysis of two Methods of Measuring Antiretroviral             Therapy           Adherence in HIV-Infected Omani Patients. Journal of the International    Association of Providers    of AIDS Care (JIAPAC).       doi:10.1177/2325958219867316
  37. Gast, A. & Mathes, T. (2019). Medication adherence influencing factors—an (updated) overview of systematic reviews. Syst Rev 8, 112. doi:10.1186/s13643-019-1014-8
  38. Gellad, W. F., Grenard, J., & McGlynn, E. A. (2009). A review of barriers to medication adherence.
  39. Global Epidemiology of HIV Infection, Update.com (2021). Retrieved from https://www.uptodate.com/contents/global-epidemiology-of-hiv-infection/print
  40. Graham, S. M., Mugo, P., Gichuru, E., Thiong’o, A., Macharia, M., Okuku, H. S., ... & Sanders, E. J. (2013). Adherence to antiretroviral therapy and clinical outcomes among young adults reporting high-risk sexual behavior, including men who have sex with men, in coastal Kenya. AIDS and Behavior, 17(4), 1255-1265.
  41. Grønborg, Kamilla Lauta, Leah Shepherdb, Magnus Gottfredssonc, Dalibor Sedlaceke, Brygida             (2018). Variation in antiretroviral treatment coverage and    virological       suppression among three    HIV key populations. Magnus, AIDS. 32(18), 2807-            2819.  doi: 10.1097/QAD.0000000000002035  
  42. Hamill, Matthew M., Hu, Fengming, Kokogho, Afoke, Shoyemi, Elizabeth, Ekeh, Charles, Charurat,Manhattan E., Robb, Merlin L.,…Crowell, Trevor. (2021).            TRUST/RV368 Study Group Factors Associated With Condom Failure in a Longitudinal Cohort of Men Who Have Sex With Men and Transgender Women in Abuja     and Lagos, Nigeria. JAIDS Journal of Acquired Immune Deficiency Syndromes.     86 (3), 329-338.  doi: 1097/QAI.0000000000002559
  43. Heckman, T. G., Anderson, E. S., Sikkema, K. J., Kochman, A., Kalichman, S. C., & Anderson, T. (2004). Emotional distress in nonmetropolitan persons living with HIV disease enrolled in a telephone-delivered, coping improvement group intervention. Health Psychology, 23(1), 94.
  44. Heestermans, T., Browne, J. L., Aitken, S. C., Vervoort, S. C., & Klipstein-Grobusch, K. (2016). Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review. BMJ global health, 1(4), e000125.
  45. Ibiloye O, Decroo T, Eyona N, Eze P, Agada P (2018). Characteristics and early clinical outcomes of key      populations attending comprehensive community-based HIV care: Experiences     from Nasarawa State, Nigeria. PLoS ONE 13(12): e0209477.
  46. Ibom E-Library (2021). www.ibomelibrary.org/
  47. Igweagu, C. P., Chime, O. H., & Ekwueme, O. C. (2019). Factors Influencing Adherence to Anti-retroviral Therapy among Persons Living with HIV/AIDS in Enugu State Southeast International Journal of TROPICAL DISEASE & Health, 39(4), 1-8. doi.org/10.9734/ijtdh/2019/v39i430211
  48. Isaac, E. , Ajani, A. , Difa, A. , Aremu, J. , Oluwaseun, O. and Hassan, M. (2021) Viral Suppression in Adult Nigerians in a Regional Antiretroviral Therapy Programme: A Cross Sectional          Descriptive Study. World Journal of AIDS, 11, 1-14. doi: 10.4236/wja.2021.111001
  49. Jaquet, A., Ekouevi, D. K., Bashi, J., Aboubakrine, M., Messou, E., Maiga, M., ... & Minga, A. (2010). Alcohol use and non‐adherence to antiretroviral therapy in HIV‐infected patients in West Africa. Addiction, 105(8), 1416-1421.

Corresponding Author

Edet, John Etim

Department of Public Health, Faculty of Allied Medical Sciences University of Calabar, Calabar