Abstract:

The economic barriers to the retention of HIV patient on treatment is a challenge to optimal viral suppression. This study examined economic factors related to retention such as employment status, food insecurity and cost of transportation to health facility that may influence retention at Wuse General Hospital, Abuja. A retrospective cohort study design was used to access economic factors that influence the retention of HIV patients on treatment. A total of 240 clients were recruited, and a pre-tested interviewer-administered semi-structured questionnaire was used for data collection. Data were entered into Stata/MP 15.0 and then exported into SPSS version 23.0 for statistical analysis. Of the 240 respondents interviewed. The findings revealed that there is an association between socio-demographic and employment status and retention in care. The results show that younger ages (20-49), being males (64.1%) and unemployed (72.3%), are more likely to be associated with retention (p<0.047). The association between socio-economic characteristics of respondents and cost of travelling to facility (p=0.016) and rural of place residence (p=0.000) was statistically significant, respectively. This study also reveals that the cost of transportation less than N200 has significant relationships with retention in at the study site (p=0.016). To address the challenges related to travel distance to health facility and high transport cost, patients should be continually encouraged to access treatment at their nearest clinic of their choice. Linking unemployed HIV patients to economic empowerment programmes will help improve their economic status.

References:

[1] Global HIV & AIDS statistics — 2020 fact sheet. https://www.unaids.org/en/resources/fact-sheet.

[2] Global HIV and AIDS statistics. Avert. 2015. https://www.avert.org/global-hiv-and-aids-statistics.

[3] NAISS, 2018, Results and Implications for Nigeria’s HIV Program. IHP. 2019. https://www.internationalhealthpolicies.org/blogs/the-2018-nigeria-hiv-aids-indicator-and-impact-survey-naiss-results-and-implications-for-nigerias-hiv-program/.

[4] Janssen, S., Wieten, R.W., Stolp S., Cremers, A.L., Rossatanga, E.G., and Klipstein-Grobusch, K., 2015, Factors associated with retention to care in an HIV clinic in Gabon, Central Africa. PLoS One, 10(10): e0140746.

[5] Taylor, B.S., Garduño, L.S., Reyes, E.V., Valiño, R., Rojas, R., and Donastorg, Y., 2011, HIV care for geographically mobile populations. Mt Sinai J Med J Transl Pers Med, 78(3):342–351.

[6] Weiser, S., Wolfe, W., Bangsberg, D., Thior, I., Gilbert, P., and Makhema, J., 200, Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. JAIDS-HAGERSTOWN MD, 34(3):281–288.

[7] Tuller, D.M., Bangsberg, D.R., Senkungu, J., Ware, N.C., Emenyonu, N., and Weiser, S.D., 2010, Transportation costs impede sustained adherence and access to HAART in a clinic population in southwestern Uganda: a qualitative study. AIDS Behav, 14(4):778–784.

[8] Olupot-Olupot, P., Katawera, A., Cooper, C., Small, W., Anema, A. and Mills, E., 2008, Adherence to antiretroviral therapy among a conflict-affected population in Northeastern Uganda: a qualitative study. Aids, 22(14):1882–1884.

[9] Senkomago, V., Guwatudde, D., Breda M., and Khoshnood, K., 2011, Barriers to antiretroviral adherence in HIV-positive patients receiving free medication in Kayunga, Uganda. AIDS Care, 23(10):1246–1253.

[10] Lankowski, A.J., Siedner MJ, Bangsberg D.R., and Tsai A.C.., 2014, Impact of geographic and transportation-related barriers on HIV outcomes in sub-Saharan Africa: a systematic review. AIDS Behav, 18(7):1199–1223.

[11] Nachega, J.B., Uthman, O.A., Mills, E.J., and Peltzer, K.., 2013, The impact of employment on HIV treatment adherence.

[12] Mills, E.J., Nachega, J.B., Bangsberg, D.R., Singh, S., Rachlis, B.., and Wu, P., 2006, Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 3(11): e438.

[13] Sousa-Ribeiro, M., Sverke, M., and Coimbra, J.L., 2014, Perceived quality of the psychosocial environment and well-being in employed and unemployed older adults: the importance of latent benefits and environmental vitamins. Econ Ind Democr, 35(4):629–652.

[14] Mukumbang, F.C., Mwale, J.C., and Van Wyk B., 2017, Conceptualising the factors affecting retention in care of patients on antiretroviral treatment in Kabwe District, Zambia, using the ecological framework. AIDS Res Treat.

[15] Swann, M., 2018, Economic strengthening for retention in HIV care and adherence to antiretroviral therapy: A review of the evidence. AIDS Care, 30(sup3):99–125.

[16] Kalichman, S.C, Grebler, T., Amaral, C.M., McKerney, M., White, D., and Kalichman, M.O., 2014, Food insecurity and antiretroviral adherence among HIV positive adults who drink alcohol. J Behav Med., 37(5):1009–1018.

[17] Haberer, J.E, Sabin, L., Amico, K.R., Orrell, C., Galárraga, O., and Tsai, A.C., 2017, Improving antiretroviral therapy adherence in resource‐limited settings at scale: a discussion of interventions and recommendations. J Int AIDS Soc, 20(1):21371.

[18] Dalhatu I, Onotu D, Odafe S, Abiri O, Debem H, Agolory S, Shiraishi RW, Auld AF, Swaminathan M, Dokubo K, Ngige E, Asadu C, Abatta E, Ellerbrock., 2016, Outcomes of Nigeria’s HIV/AIDS Treatment Program for Patients Initiated on Antiretroviral Treatment  between 2004-2012

[19] Pelzer, B., Schaffrath, S., and Vernaleken I., 2014, Coping with unemployment, The impact of unemployment on mental health, personality, and social interaction skills. Work, 48(2):289–295.

[20] Van Hal, G., 2015, The true cost of the economic crisis on psychological well-being: a review. Psychol Res Behav Manag, 8:17.

[21] Murphy, G.C., and Athanasou J.A., 1999, The effect of unemployment on mental health. J Occup Organ Psychol, 72(1):83–99.

[22] Milloy, M-J, Kerr, T., Bangsberg, D.R., Buxton J., Parashar S., and Guillemi, S., 2012. Homelessness as a structural barrier to effective antiretroviral therapy among HIV-seropositive illicit drug users in a Canadian setting. AIDS Patient Care STDs, 26(1):60–67.

[23] Young, S., Wheeler A.C., McCoy S.I., and Weiser, S.D., 2014, A review of the role of food insecurity in adherence to care and treatment among adult and pediatric populations living with HIV and AIDS. AIDS Behav, 18 Suppl 5: S505-515.

[24] Maskew, M., MacPhail, P., Menezes C., and Rubel D., 2007, Lost to follow up – contributing factors and challenges in South African patients on antiretroviral therapy, 97(9):5.

[25] Braitstein, P., Boulle, A., Nash, D., Brinkhof, M.W., Dabis, F., and Laurent, C., 2008, Gender and the use of antiretroviral treatment in resource-constrained settings: findings from a multicenter collaboration. J Women’s Health, 17(1):47–55.

[26] Puskas, C.M, Forrest, J.I., Parashar, S., Salters, K.A., Cescon A.M. and Kaida A., 2011, Women and vulnerability to HAART non-adherence: a literature review of treatment adherence by gender from 2000 to 2011. Curr HIV/AIDS Rep, 8(4):277–287.