Abstract:

Adherence to antiretroviral therapy (ART) among people living with human immunodeficiency virus (PLHIV) is very imperative in achieving successful treatment outcome and decreased risk of HIV transmission to uninfected people. This is a randomized controlled trial study conducted in Adamawa State, Nigeria. 244 patients were randomized to intervention or control group. Data obtained from the study was analyzed using SPSS Version 21. Frequencies distributions, descriptive statistics were presented, Inferential statistics such as Pearson Chi square, McNemar’s test, Paired T test, correlation and repeated measures ANOVA were used to measure the strength of associations and relationships between the various variables and probability of statistically significant level set < 0.05 at 95% Confidence interval. The response rates in the intervention and control groups were 99% and 96.7% at 3 months; 97.5% and 92.6% at 6 months, respectively. Individual socio-demographic characteristics were not found to be associated with adherence levels in this study. At six months follow up the proportion of the respondents who had good adherence (>95%) was higher (89.1%) and statistically significant (p= 0.001) in the intervention group compared to control group (63.1%) and (p= 0.617). A significantly higher frequency in missed clinic appointments (7.98 vs 1.68) (p=0.024) was noticed in the control group, and a statistically significant increase in the proportion of participants who reported an increase in weight (p=0.001), CD4 cells counts (p=0.001) and decrease in the presence of tuberculosis and other opportunistic infections were observed among patients in the intervention group.

References:

[1] Joint United Nation Programme on HIV/AIDS (UNAIDS, 2018). Global HIV & AIDS statistics. 2018 fact sheet. http://www.unaids.org/en/resources/fact-sheet).

[2] National Agency for Control of AIDS (NACA) (2017). ‘National Strategic Framework on HIV and AIDS: 2017 -2021. Page 6-16 https://www.childrenandaids.org/sites/default/files/201711/NATIONAL-HIV-AND AIDS-STRATEGIC FRAMEWORK.pdf.

[3] National HIV Sero-prevalence Sentinel Survey (NHSS 2014).

[4] Bekele Belayihun1 and Rahma Negus (2015). Antiretroviral Treatment Adherence Rate and Associated Factors among People Living with HIV in Dubti Hospital, Afar Regional State, East Ethiopia. Hindawi Publishing Corporation International Scholarly Research Notices Volume 2015, Article ID 187360, 5 pages. http://dx.doi.org/10.1155/2015/187360.

[5] World Health Organization. (WHO, 2005) Interim WHO clinical staging of HIV/AIDS and HIV/AIDS case definitions for surveillance: African region. Switzerland: https://www.who.int/hiv/pub/guidelines/clinicalstaging.pdf.

[6] Paterson DL, Swindells S, Mohr J, Brester M, Vergis EN, Squier C, et al. (2002) Adherence to protease inhibitor therapy and outcomes in patients with HIV infection. Annals of internal medicine. 2000;133(1):21–30. pmid:10877736.

[7] Suleiman IA, Momo A. Adherence to antiretroviral therapy and its determinants among persons living with HIV/AIDS in Bayelsa state, Nigeria. Pharmacy Practice 2016 Jan-Mar;14(1):631. doi: 10.18549/PharmPract.2016.01.631.

[8] Kelley LL' Engle, Kimberly Green MA, Stacey M Succop et al., (2015). Scaled-Up Mobile Phone Intervention for HIV Care and Treatment: Protocol for a Facility Randomized Controlled Trial. JMIR Res Protoc 2015;4(1): e11) doi:10.2196/resprot.3659 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4319075/.

[9] National Guideline for HIV Prevention Treatment and Care (2016)- Nigeria. http://apps.who.int/medicinedocs/documents/s23252en/s23252en.pdf.

[10] President Emergency Plan for AIDS Relief (PEPFAR) (2016). Country/Regional Operational Plan (COP/ROP) 2016 guidance. Office of the U.S. Global AIDS Coordinator, Washington, D.C.: OGAC;2015.

[11] World Health Organization (WHO, 2015). Guideline on when to start antiretroviral therapy and on pre-exposure prophylaxis for HIV. Geneva: World Health Organization 2015 (http://www.who.int/hiv/pub/guidelines/earlyrelease-arv/en.

[12] Lemeshow S, David W. Ho, J Klar, S K. Lwanga and World Health Organization (1990). Adequacy of sample size in health studies. WHO IRIS: 239. http://www.who.int/irs/handle/10665/41607.accessed.

[13] Olowookere, S.A., Fatiregun, A.A, Ladipo, M.M.A, Abioye-Kuteyi, E.A. & Adewole, I.F. (2016). Effects of adherence to antiretroviral therapy on body mass index, immunological and virological status of Nigerians living with HIV/AIDS. Alexandria Journal of Medicine (2016) 52, 51–54.

[14] Anoje, C., Agu, K.A., Oladele, E.A., Badru, T., Adedokun, O., Oqua, D., Khamofu, H., Adebayo, O., Torpey, K., Chabikuli, O.N. (2017). Adherence to On-Time ART Drug Pick-Up and Its Association with CD4 Changes and Clinical Outcomes Amongst HIV Infected Adults on First-Line Antiretroviral Therapy in Nigerian Hospitals AIDS Behav. 2017 Feb;21(2):386-392. doi: 10.1007/s10461-016-1473-z.

[15] Applebaum AJ, Richardson MA, Brady SM, Brief DJ, keane TM (2009). Gender and Other psychosocial factors as predictors of adherence to HAART in adults with comorbid HIV/aids, psychiatric and substance related disorder. Aids Behav. ;13(1):60–5.

[16] Carrieri MP, Chesney MA, Spire B, et al. (1999). Failure to maintain adherence to HAART in a cohort of French HIV-positive injecting drug users. Int J Behav Med. 2003; 10:1–14.8. Holzemer WL, Corless IB, Nokes KM, et al (2000). Predictors of self-reported adherence in persons living with HIV disease. AIDS Patient Care STDS.13:185–97.9.

[17] Bouhnik AD, Chesney M, Carrieri P, et al. (2002) Non adherence among HIV-infected injecting drug users: the impact of social instability. J Acquire Immune Defic Syndr. ;31(suppl 3): S149 –S153.10.

[18] Golin CE, Liu H, Hays RD, et al. (2002). A prospective study of predictors of adherence to combination antiretroviral medication. J Gen InternMed. 2002; 17:756 – 65.11.

[19] Gordillo V, del Amo J, Soriano V, Gonzalez-Lahoz J. (1999) Socio demo-graphic and psychological variables influencing adherence to antiretroviral therapy. AIDS.13:1763–9.12.

[20] Chesney, M.A. (2000). Factors affecting adherence to antiretroviral therapy. Clinical Infectious Disease 2000; 30 S171–S76.

[21] Eldred LJ, Wu AW, Chaisson RE, Moore RD (1998) Adherence to antiretroviral and pneumocystis prophylaxis in HIV disease. J Acquired Immune Defic Syndr Hum Retrovirol.; 18:117–25.5.

[22] Moatti J.P, Carrieri M.P, Spire B, Gastaut J.A, Cassuto J.P, Moreau J. (2000) Adherence to HAART in French HIV-infected injecting drug users: the contribution of buprenorphine drug maintenance treatment. The Manif 2000 study group. AIDS. 2000; 14:151–5.6.

[23] Wagner, G.J. (2002). Predictors of antiretroviral adherence as measured by self-report, electronic monitoring, and medication diaries. AIDS Patient Care STDS. 16:599 – 608.

[24] Nduaguba, S.O., Soremekun, R.O., Olugbake, O.A., & Barner, J.C (2017). The relationship between patient-related factors and medication adherence among Nigerian patients taking highly active anti-retroviral therapy. Africa Health Science. 17(3): 738–745.

[25] Bonolo, P.F., Ceccato, M.B., Rocha, G. M., Acúrcio, F.A., Campos, L. N., & Guimarães, M. C. (2013). Gender differences in non-adherence among Brazilian patients initiating antiretroviral therapy. Clinics (Sao Paulo). 68, 612–620.

[26] Simoni, J.M., Pearson, C.R., Pantalone, D.W., et al. (2006) Efficacy of interventions in improving highly active antiretroviral therapy adherence and HIV-1 RNA viral load. A meta-analytic review of randomized controlled trials. Journal Acquired Immune Deficiency Syndrome 43(Suppl 1): S23–S35.

[27] Wagner, G.J, Kanouse, D.E., Golinelli, D., et al (2006). Cognitive-behavioral intervention to enhance adherence to antiretroviral therapy: a randomized controlled trial (CCTG 578) AIDS 20:1295–1302.

[28] Carrico, A.W, Antoni, M.H., Duran, R.E., et al. (2006). Reductions in depressed mood and denial coping during cognitive behavioral stress management with HIV-positive gay men treated with HAART. Annual Behavior Medicine 31:155–164.

[29] Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP, de Walque D, et al. (2011). Mobile phone technologies improve adherence to antiretroviral treatment in a resource-
limited setting: a randomized controlled trial of text message reminders. AIDS. 2011;25(6):825–34. pmid:21252632.

[30] Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, Chung MH, et al. (2010). Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomized trial. Lancet. 2010;376(9755):1838–45. pmid:21071074 [doi:10.1016/S0140-6736(10)61997-6].

[31] Woods SP, Moran LM, Carey CL, Dawson MS, Iudicello JE, et al. (2008) Prospective memory in HIV infection: is ‘‘remembering to remember’’ a unique predictor of self-reported medication management? Arch Clin Neuropsychology 23:257–270.

[32] Chung MH, Richardson BA, Tapia K, Benki-Nugent S, Kiarie JN, Simoni JM, et al. (2011). A randomized controlled trial comparing the effects of counseling and alarm device on HAART adherence and virologic outcomes. PLoS Medicine. 2011;8(3): e1000422. pmid:21390262.

[33] Abdulrahman SA, Rampal L, Ibrahim F, Radhakrishnan AP, Kadir Shahar H, Othman N (2017) Mobile phone reminders and peer counseling improve adherence and treatment outcomes of patients on ART in Malaysia: A randomized clinical trial. PLoS ONE 12(5): e0177698. https://doi.org/10.1371/journal.pone.0177698.

[34] Kunutsor S, Walley J, Katabira E, Muchuro S, Balidawa H, Namagala E, et al. Using mobile phones to improve clinic attendance amongst an antiretroviral treatment cohort in rural Uganda: A cross-sectional and prospective study. AIDS Behav. 2010; 14(6): 1347±1353. https://doi.org/10.1007/s10461-010-9780-2 PMID: 20700644.

[35] Sarna A, Luchters S, Geibel S, Chersich MF, Munyao P, Kaai S, et al. Short-and long-term efficacy of modified directly observed antiretroviral treatment in Mombasa, Kenya: a randomized trial. J Acquir Immune Defic Syndr. 2008; 48(5), 611±619. https://doi.org/10.1097/QAI.0b013e3181806bf1 PMID:18645509.

[36] Rich ML, Miller AC, Niyigena P, Franke MF, Niyonzima JB, Socci A, et al. (2012). Excellent Clinical Outcomes and High Retention in Care among Adults in a Community-Based HIV Treatment Program in Rural Rwanda J Acquire Immune Defic Syndr. 2012; 59(3): e35±e42. https://doi.org/10.1097/QAI.0b013e31824476c4 PMID: 22156912.

[37] Mannheimer S, Friedland G, Matts J, Child C, Chesney M. The consistency of adherence to antiretroviral therapy predicts biologic outcomes for human immunodeficiency virus infected persons in clinical trials. Clin Infect Dis. 2002; 34:1115–21.

[38] El-Khatib Z, Ekstrom AM, Coovadia A, Abrams EJ, Petzold M, et al. (2011) Adherence and virologic suppression during the first 24 weeks on antiretroviral therapy among women in Johannesburg, South Africa - a prospective cohort study. BMC Public Health 11: 88.

[39] Sampaio-Sa M, Page-Shafer K, Bangsberg DR, et al. 100% adherence study: educational workshops vs video sessions to improve adherence among ART-naive patients in Salvador, Brazil. AIDS Behaviour. 2008;12(4 Suppl): S54–S62.

[40] Garcia R, Ponde M, Lima M, Souza AR, Stolze SM, Badaro R. Lack of effect of motivation on the adherence of HIV-positive/AIDS patients to antiretroviral treatment. Braz J Infect Dis. 2005;9(6):494–499.