Retention in care and adherence to HIV and AIDS treatment in Anambra State Nigeria

Chukwuma David Umeokonkwo,Muhammad Shakir Balogun,Pearl Adaoha Agu,Chima Ariel Onoka,Lawrence Ulu Ogbonnaya,Edmund Ndudi Ossai

doi:10.1186/s12879-019-4293-8

Abstract

BackgroundRetaining patients on antiretroviral treatment in care is critical to sustaining the 90:90:90 vision. Nigeria has made some progress in placing HIV-positive patients on treatment. In an effort to increase access to treatment, ART decentralization has been implemented in the country. This is aimed at strengthening lower level health facilities to provide comprehensive antiretroviral treatment. We determined the level of retention and adherence to treatment as well as the associated factors among private and public secondary level hospitals in Anambra State.MethodWe conducted a cross-sectional study among patients who had taken antiretroviral treatment for at least one complete year. A structured questionnaire and patient record review were used to extract information on patient adherence to treatment, and retention in care. Adherence to treatment was ascertained by patient self-report of missed pills in the 30 days prior to date of interview. Retention in care was ascertained using the 3-month visit constancy method reviewing the period spanning 12 months prior to the study.ResultWe found a comparable level of retention in care (private 81.1%; public 80.3%; p = 0.722). However, treatment adherence was significantly higher amongst participants in the private hospitals compared to those in the public hospitals (private: 95.3%; public: 90.7%; p = 0.001). Determinants of good retention in the private hospitals included disclosure of one’s HIV status (AOR: 1.94, 95% CI: 1.09–3.46), being on first-line regimen (AOR: 3.07, 95% CI: 1.27–7.41), whereas being on once-daily regimen (AOR: 0.58, 95% CI: 0.36–0.92), and being currently married (AOR: 0.54 95% CI: 0.32–0.91) determined poor retention. In the public hospitals, only disclosure (AOR: 3.12 95% CI: 1.81–5.56) determined good retention, whereas, spending less than N1000 on transport (AOR: 0.230 95% CI: 0.07–0.78) and residing in a rural area (AOR: 0.64 95% CI: 0.41–0.99) determined poor retention. None of the factors determined adherence.ConclusionRetention in care was high and comparable among the different hospital types and HIV disclosure status was an important factor relating to retention in care. The other factors that determined retention were however different at public and private hospitals. The HIV program manager should consider these variations in designing programs to improve patient retention in care and adherence to treatment.

Highlights

Retaining patients on antiretroviral treatment in care is critical to sustaining the 90:90:90 vision
Retention in care was high and comparable among the different hospital types and HIV disclosure status was an important factor relating to retention in care
The HIV program manager should consider these variations in designing programs to improve patient retention in care and adherence to treatment

Summary

Introduction

Retaining patients on antiretroviral treatment in care is critical to sustaining the 90:90:90 vision. Adherence to treatment and retention in care are critical to achieving these outcome through viral suppression [1,2,3,4,5]. Some of the major objectives of care and treatment of HIV/AIDS are to reduce morbidity and mortality as well as improve the quality of life of the PLWHA. These objectives among other factors are intricately linked to the achievement of optimal viral suppression which in turn depends on the level of adherence of the patient to treatment. Sustained period of good adherence (not less than 95%) to therapy is required to achieve adequate viral suppression which in turn is a predictor of good clinical outcome

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Conclusion