Medication Adherence and Health Status in HIV Positive Patients in Akwa Ibom State, Nigeria

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

Measuring patient engagement with HIV care in sub‐Saharan Africa: a scoping study

“…Monitoring change in self‐reported adherence improved sensitivity [ 86 ] and self‐reports can trigger a discussion within a consultation with a shared understanding of engagement between the patient and healthcare worker [ 121 ]. Self‐reports are also low cost, easily implemented [ 15 ] and can discriminate between intentional and unintentional non‐adherence [ 61 ], especially useful for individual patient evaluation to direct the management plan.…”

“…• Routine evaluation of engagement in patients in facility care [6,61,62,77,78] • Rationalize resources, such as expensive genotype [33,[79][80][81][82] or viral load [50,[82][83][84][85][86][87] testing and resources to trace those lost to follow-up [88] • Understanding the behaviour of people on ART [15,21,25,63,65, • Routine evaluation of engagement in patients in differentiated service delivery models [49,119] • Flag patients early for intervention [57,[120][121][122][123][124][125][126][127][128][129] • a At facility and population levels for quality improvement and strategic decision-making.…”

Antimicrobial Stewardship for Outpatients with Chronic Bone and Joint Infections in the Orthopaedic Clinic of an Academic Tertiary Hospital, South Africa

“…As a result, a score of 12-22 reflected high adherence, 23-36 medium adherence, and 37-48 low adherence. There were no studies that were published using this scale in chronic bone and joint infections based on the literature review; however, there have been similar studies with this scale, researching other chronic conditions including diabetes and HIV [64,65].…”