Abstract
Purpose: To assess medication adherence and health status in ambulatory HIV positive patients in Akwa Ibom State, Nigeria.Methods: The 7-item Adherence to Refills and Medication Scale (ARMS-7) was used to assess medication adherence among 500 HIV positive patients in three secondary health facilities in Akwa Ibom State, Nigeria. A single-item question (measuring self-rated health) and depression (CESD-R) questionnaire were also used to evaluate the patients. Recent CD4 count and viral load were obtained from the patients’ folders. The association between independent and dependent variables was evaluated using logistic regression analysis.Results: Only 56 (11.7%) respondents reported 100% adherence to their medications; 190 (39.7%) rated their health as being ‘very good’ and 51 (10.7%) reported being depressed. Respondents who were single were more likely to be nonadherent (aOR = 2.665, 95% CI = 1.336 - 5.318; p = 0.005), and the nonadherent patients were more likely to have lower CD4 cell counts (aOR = 0.998, CI = 0.996 – 0.999; p = 0.007). Those who rated their health as ‘fair’ or ‘poor’ were more likely to be nonadherent (aOR= 11.380, CI = 1.527 – 84.785; p=0.018) and depressed (aOR = 2.748, CI = 1.469 – 5.141; p = 0.002). Patients who were unemployed were more likely to rate their health as fair/poor (aOR = 1.890, CI = 1.197 – 2.985; p=0.006).Conclusion: This work has shown that even though most of the HIV positive patients perceive their health as being very good, their adherence to medications was poor which is directly related to their unemployment status. Intervention to improve adherence directed at socio-economic status of the individual patient is recommended.
 Keywords: Medication adherence; Depression; Self-rated health; Nigeria
Highlights
The goals of antiretroviral therapy (ART) are to achieve rapid, maximal and sustained suppression of viral load, preserve or improve immunologic function, reduce the risk of transmission of human immunodeficiency virus (HIV) to sexual partners, prevent mother-to-child transmission, prolong life and improve the overall well-being of persons infected with HIV [1]
Variability in adherence and clinical outcomes has been observed in HIV infected individuals who are on ART
At the time of data collection, the HIV/Acquired Immune Deficiency Syndrome (AIDS) clinics in these hospitals were supported by Family Health International (FHI, a non-governmental organization) in partnership with the United States Agency for International Development (USAID)
Summary
The goals of antiretroviral therapy (ART) are to achieve rapid, maximal and sustained suppression of viral load, preserve or improve immunologic function, reduce the risk of transmission of human immunodeficiency virus (HIV) to sexual partners, prevent mother-to-child transmission, prolong life and improve the overall well-being of persons infected with HIV [1]. These benefits cannot be obtained if HIV positive persons are not adherent to their medications. Nonadherence to medication is common among all patient populations among those with chronic illnesses [6]
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