Adherence to Antiretroviral Therapy in HIV-Positive Patients in Ethiopia: Review

Abstract

Background: Highly active antiretroviral therapy (HAART) offered HIV-positive individuals tremendous lifesustaining benefits. The benefits are sustainable only through optimal adherence. This systematic review was conducted to synthesize the available studies in order to determine average adherence, identify variables associated with adherence and shed light on the design and improvement of adherence studies and interventions. Method: Studies were selected from electronic databases (Pubmed, Hinari, Google scholar) using HAART or Highly active antiretroviral therapy and adherence [Ethiopia] as search terms. Each study was summarized by using format containing: characteristics of the study, sample size, study design and measures of adherence, factors associated with adherence, reasons for missing dose. Result: A total of 17 studies: 16 cross-sectional and 1 prospective study reporting adherence to HAART in Ethiopian HIV-positive patients were identified in our search items. Almost all of adherence to HAART studies conducted in Ethiopia used cross-sectional study design with self-report as adherence measurement. Though from the lowest evidence design the adherence rate in Ethiopia were higher than many developed countries report. Social support is major positive predictor of adherence to HAART while depression and substance abuse were negative predictors'. Conclusion: We demonstrated a better self-reported adherence to HAART in Ethiopian HIV-positive patients. However rate and determinants of HAART in Ethiopian HIV-positive patients are poorly defined. The type of study design used and the use of self-report (subjective measure) in adherence assessment made adherence to HAART unexplored in Ethiopia. Further studies should be conducted using prospective cohort and interventional study design using varying methods of adherence measurement.

Poor adherence to highly active antiretroviral therapy and associated factors among people living with HIV in Eastern Ethiopia

“…11 The report from different studies conducted in Ethiopia revealed that the level of optimal adherence ranges from 72.4% to 94.3%, which indicates that HAART adherence is remaining suboptimal. 12 The roots of poor adherence to HAART are extremely varied, and adherence is associated with many individuals and facility-related factors. The findings of studies carried out in some developing countries like India, Nepal, Togo, and Nigeria identified that females, daily alcohol consumers, and people with depressive symptoms are less likely to adhere to HAART.…”

Reliability, validity and measurement invariance of the Simplified Medication Adherence Questionnaire (SMAQ) among HIV-positive women in Ethiopia: a quasi-experimental study

“…There is a dearth of literature on use of standardized scales to measure medication adherence among people on ART in Ethiopia. A systematic review of 15 ART adherence studies in Ethiopia reported that 60% of the studies used self-reports, other methods included: caregiver reports, unannounced pill counts, pharmacy refill record, medication event monitoring systems, viral load measurement, CD4 count and record review [17]. Some studies have reported challenges associated with various methods of assessing adherence among users of ART in Ethiopia.…”

“…Both studies reported that self-reports overstated adherence levels compared to unannounced pill count due to social desirability bias, in addition to being susceptible to recall bias [19,20]. The authors reported that despite their limitations, self-reports and pill count are widely used in Ethiopia because they are cheaper and easy to implement [17]. Self-reports have also been found to correlate with viral load and clinical outcomes [17].…”

“…The authors reported that despite their limitations, self-reports and pill count are widely used in Ethiopia because they are cheaper and easy to implement [17]. Self-reports have also been found to correlate with viral load and clinical outcomes [17].…”