Retention in Care and Adherence to Treatment among People Living with HIV in Secondary Level Hospitals in Anambra State Nigeria: A Comparative Study

Abstract

Background: Adherence to antiretroviral treatment (ART) and retention in care are critical to achieving the 90:90:90 UNAIDS vision. Nigeria implemented ART decentralization to increase access to treatment. This strengthened lower level hospitals to provide comprehensive antiretroviral treatment. Nigeria has over 800,000 people on antiretroviral treatment. We determined the level of retention and adherence to treatment and associated factors among private and public secondary level hospitals in Anambra State Nigeria. Methods & Materials: We conducted a comparative cross-sectional study among 1,270 adult out-patients who had received antiretroviral treatment for at least one year prior to the study. A structured pre-tested questionnaire and checklist for patient's record review were used. Adherence to treatment was ascertained by patient self-report of missed pills 30days prior to date of interview. Retention in care was ascertained using the 3-months visit constancy method reviewing the period spanning 12months prior to study. Proportions, Chi Square and logistic regression analysis were conducted. Results: Twenty-eight percent (359) were male and mean age of the participants was 40.1 ± 9.9years. A comparable proportion of patient retained in care [private 81.1%, public 80.3%, p = 0.722]. The proportion of participants in the private hospitals who were adherent to their treatment were significantly more than those in public hospitals [private 95.3%, public 90.7%, p = 0.001]. Disclosing one's HIV status [adjusted odds ratio (AOR); 1.94, 95%CI: 1.09–3.46], being on first line regimen [AOR: 3.07, 95%CI: 1.27-7.41], being on once daily regimen [AOR: 0.58, 95%CI: 0.36-0.92], and currently married [AOR: 0.54, 95%CI: 0.32-0.91] were independent predictors of adequate retention in private hospitals. While in public hospital, disclosing HIV status [AOR: 3.12, 95%CI: 1.81-5.56], spending ≤ N1000 on transport [AOR: 0.23, 95%CI: 0.07-0.78] and residing in rural area [AOR: 0.64, 95%CI: 0.41-0.99] were independent predictors adequate retention in care. None of the factors examined were associated with adherence to treatment. Conclusion: Private and public secondary hospitals had comparable proportions of patient retention but not in adherence to treatment. Disclosure of HIV status should be encouraged to improve retention in care. Proportion of patient retained in care both hospital types was still suboptimum. Efforts should be targeted at improving retention in care among PLHIV.