Magnitude of non-adherence to antiretroviral therapy and associated factors among adult people living with HIV/AIDS in Benishangul-Gumuz Regional State, Ethiopia

Abstract

Introduction Following global efforts to increase antiretroviral therapy (ART) access and coverage, Ethiopia has made significant achievement with a 6.3% annual decline in the HIV/AIDS incidence rate between 1990 and 2016. Such success depends not only on access to ART but also on attaining optimum treatment adherence. Emerging studies in Ethiopia has shown the increasing prevalence of poor adherence and lack of the desired viral suppression, but the extent and factors associated with non-adherence to ART are not well known, especially in the current study setup. In this study, we examined the magnitude and factors associated with treatment and non-adherence to ART among people living with HIV in Benishangul-Gumuz Regional State, northwest Ethiopia. Methods An institutional facility based cross-sectional descriptive study was carried out among adult people living with HIV/AIDS from mid-December 2016 to February 2017 with only 98.9% response rate. Sociodemographic factors (age, gender, marital status and residential area), economic factors (educational status, income, asset possession, employment status, dietary diversity, nutritional status and food security), and clinical characteristics (CD4 count, duration on ART and history of opportunistic infections) were explanatory variables. ART non-adherence was measured using a visual analogue scale (VAS). We used binary logistic regression and subsequent multivariate logistic regression analysis to determine the factors associated with ART non-adherence. Result Overall, 39.7% of the participants were found non-adherent to ART. Strong association was found between non-adherence to ART and young age below 25 years (AOR: 4.30, 95% CI [1.39–3.35]; p = 0.011), urban residential area (AOR: 2.78, CI [1.23–7.09], p = 0.043), lack of employment (AOR: 1.75, 95% CI [1.05–2.91], p = 0.032), food insecurity (AOR: 2.67, 95% CI [7.59–8.97]; p < 0.0001), malnutrition (AOR: 1.55, 95% CI [1.94–2.56]; p = 0.027) and opportunistic infections (AOR: 1.81, 95% CI [1.11–2.97]; p = 0.018). Conclusion The prevalence of non-adherence to ART in this study was high. Sociodemographic and economic factors such as young age of below 25 years, urban residential area, lack of employment, food insecurity, malnutrition and opportunistic infections were among the factors associated with non-adherence to ART.

Neurocognitive decline as a major predictor of nonadherence to antiretroviral therapy among adults living with HIV in Dodoma region, central Tanzania

“…39 The diversity in nonadherence rates is reported elsewhere in Sub‐Saharan Africa; for example, 9.4% ART nonadherence rate was reported in an AIDS indicator survey in Kenya, 34 14.4% in Batu town Ethiopia, 40 18.8% in Addis Ababa Ethiopia 41 and 17.02% in Sudan 35 : Interestingly, a much higher suboptimal adherence of 48% and 39.7% are reported in Nairobi, Kenya, and Benishangul‐Gumuz in Ethiopia, respectively. 42 A relatively better adherence rate observed in this study could partly be explained by specific programs within the study population that target improving adherence and use of the CTC services. These programs utilize the designated team leaders who follow up and trace members and address challenges that affect their medication adherence and retention in HIV care.…”

“…Interestingly, a much higher suboptimal adherence of 48% and 39.7% are reported in Nairobi, Kenya, and Benishangul-Gumuz in Ethiopia, respectively. 42 A relatively better adherence rate observed in this study could partly be explained by specific programs within the study population that target improving adherence and use of the CTC services. These programs utilize the designated team leaders who follow up and trace members and address challenges that affect their medication adherence and retention in HIV care.…”

“…The 10.32% prevalence of suboptimal adherence to ART corresponds to an 89.68% adherence rate which is lower than the national recommended ART adherence target of ≥95% 39 . The diversity in nonadherence rates is reported elsewhere in Sub‐Saharan Africa; for example, 9.4% ART nonadherence rate was reported in an AIDS indicator survey in Kenya, 34 14.4% in Batu town Ethiopia, 40 18.8% in Addis Ababa Ethiopia 41 and 17.02% in Sudan 35 : Interestingly, a much higher suboptimal adherence of 48% and 39.7% are reported in Nairobi, Kenya, and Benishangul‐Gumuz in Ethiopia, respectively 42 . A relatively better adherence rate observed in this study could partly be explained by specific programs within the study population that target improving adherence and use of the CTC services.…”

The role of health facility and individual level characteristics on medication adherence among PLHIV on second-line antiretroviral therapy in Northeast Ethiopia: use of multi-level model

“…Furthermore, most previous studies have focused on individual-level determinants and failed to examine the role of health facility characteristics on patient medication adherence [ 15 – 18 ]. To the best of our knowledge, no research has been done in the Ethiopian health system context to assess the impact of individual-level and health facility characteristics on medication adherence for PLHIV on second-line ART.…”

Adherence to Antiretroviral Treatment Among People Who Started Treatment on the Same-Day of HIV Diagnosis in Ethiopia: A Multicenter Observational Study

“…5 In Ethiopia, based on recent observational studies that assessed self-reported adherence using clinician's-record, optimal adherence ranged between 60.3% and 94.8% and varied by region. [6][7][8] On the other hand, a metaanalysis of studies conducted in sub-Saharan Africa identified that use of alcohol, male gender, use of traditional/ herbal medicine, dissatisfaction with healthcare facility and healthcare workers, depression, discrimination and stigmatization, and poor social support as factors associated with non-adherence. 5 A study conducted in other setting also showed that gender and marital status have significant association with ART adherence.…”