Hindawi Publishing Corporation ISRN AIDS Volume 2013, Article ID 873939, 7 pages http://dx.doi.org/10.1155/2013/873939
Research Article Predictors of Adherence to Antiretroviral Therapy among HIV/AIDS Patients in the Upper West Region of Ghana Christian Obirikorang,1 Peter Kuugemah Selleh,2 Jubilant Kwame Abledu,3 and Chris Opoku Fofie4 1
Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana 2 Department of Medical Laboratory Technology, Faculty of Allied Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana 3 School of Veterinary Medicine, University of Ghana, Legon, Ghana 4 Ghana Health Service, Upper West Regional Hospital, Wa, Upper West Region, Ghana Correspondence should be addressed to Christian Obirikorang; [email protected] Received 24 September 2013; Accepted 20 October 2013 Academic Editors: R. Ansari and V. C. Bond Copyright © 2013 Christian Obirikorang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The effectiveness of ART interventions is only realized in maximal levels of adherence. A near perfect adherence level of >95% is required for the effective suppression of HIV/AIDS virus. The main objective of this study was to identify the sociodemographic and socioeconomic factors that facilitate adherence to antiretroviral therapy among HIV/AIDS patients. Methods. This descriptive cross-sectional study was conducted between March and May 2013 at the Upper West Regional Hospital, Wa. A total of 201 confirmed HIV 1 seropositive subjects (mean age 36.6±9.9 years) receiving antiretroviral therapy were interviewed using a structured questionnaire. The collected data was analyzed using GraphPad Prism version 5. A 𝑃 value of 75%). This
accounts for the increasing number of women being affected worldwide. Homosexual intercourse is the second commonest route of transmission [2]. Sub-Saharan Africa bears the greatest burden with more than two-thirds (68%) of all persons infected with HIV. An estimated 1.8 million adults and children became infected with the disease in Sub-Saharan Africa. It is recorded that out of 260,000 child deaths that occurred globally from HIV/AIDS in 2009, 88% occurred in Sub-Saharan Africa [3]. The HIV/AIDS epidemic in Ghana continues to be a generalized epidemic with a prevalence of more than 1% in
2 the general population. Promising developments have been seen in recent years in global efforts to address the AIDS epidemic, including increased access to effective treatment and prevention programmes [4]. The number of HIV patients receiving ART in Ghana increased more than 200-fold from 197 in 2003 to over 45,000 in 2010. Some regions report ART enrollment lower than their percent share of number of HIV infected persons in the country [5]. The world Health Organization recommendations on the use of ART in resource-limited settings recognize the critical role of adherence in order to achieve clinical and pragmatic success. Good adherence to ART is necessary to achieve the best antivirological response, lower the risk that drug resistance will develop, and reduce morbidity [6]. Combination therapies of ARV drugs are the treatment of choice in HIV, and nonadherence is a major, if not the most important, factor in treatment failure and the development of resistance. 100% medication adherence is paramount for the effective management of HIV [2] and provision of free treatment without adequate patient preparation and adherence support may compromise the success of ART scale-up programmes [7]. A major concern with scaling up of antiretroviral therapy (ART) in resource-limited settings is the emergence of drug resistant viral strains due to suboptimal adherence and the transmission of these resistant viral strains in the population [7]. In view of the changing trend in prevalence of HIV in Ghana and the lack of data surrounding medication adherence in this population, this study therefore proposed to assess the level of and validate (using CD4 results) selfreported adherence and its predictors among patients attending the HIV Clinic of Upper West Regional Hospital, Wa.
2. Materials and Methods This descriptive cross-sectional study was conducted at the Upper West Regional Hospital situated in the southern part of the capital Wa. It is the only specialized referral hospital in the region and the HIV unit currently provides service to over 1600 registered HIV/AIDS patients on antiretroviral drugs. The study was conducted between the months of March and May 2013. A total of two hundred and one (201) confirmed HIV 1 seropositive subjects receiving antiretroviral therapy were interviewed using a structured questionnaire with both open and close ended questions. Primary data was also obtained from their medical records after obtaining permission from the health facility administrators and consent from patients. The Committee on Human Research, Publications and Ethics, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, gave ethical approval for the study to be conducted. Confidentiality, anonymity, and privacy were guaranteed. 2.1. Data Collection. A structured questionnaire which was developed from different literatures was used for the data collection. The dependent variable was adherence to highly active antiretroviral therapy (HAART) among PLWHA. The independent variables were sociodemographic (age, sex, weight, level of education, occupation, marital status, and
ISRN AIDS family type), socioeconomic variables (income), psychosocial (social support, active substance and alcohol use, disclosure of HIV serostatus, and perception of well-being), disease characteristics (duration of HIV infection), regimen related variables (types of ART, dietary related demands/restriction, and side effect), CD4 at diagnosis and current value, followups, adherence to treatment information and symptoms associated with treatment. Many researchers who have conducted studies in this area found that there is no existing gold standard by which adherence can be quantified and many predictors have been reported to influence it. The study therefore chose five measurement tools to quantify adherence from self-recalled report data collected from participants at exit face-to-face interviews: (A) lifetime self-recall adherence, (B) last 6 months’ self-recall adherence, (C) last 3 months’ self-recall adherence, (D) last month’s self-recall adherence, (E) last week’s self-recall adherence. Participants were asked if they had ever missed medication in their lifetime beginning from the time s/he was put on antiretroviral therapy. Self-reported adherence was classified as “adherent” when not a single dose was missed or nonadherent if the patient admitted having missed at least one dose. They were asked about adherence to medication since initiation of ART as listed above. This means that patients’ memory of medicine intake was likely to be good. However, in such face-to-face interviews patients might feel ashamed to report missed medications. Hence participants were assured of confidentiality for their response and they were made aware that, even though medically precarious, every individual could miss medication for one reason or the other. 2.2. Data Management and Analysis. Data collected was sorted, coded, and entered into an Excel spreadsheet for analysis using GraphPad Prism for Windows version 5.0 (GraphPad Software, San Diego, CA, USA). Descriptive statistics such as mean, frequencies, and percentages were used to summarize the data. Overall lifetime adherence to medication was determined from the data and predictors determined. Analysis of contingency tables was done and Fisher’s exact test and the chi-square test were used where necessary to compare proportions. Logistic regression analysis was used to determine the relationships between adherence and other variables (level of significance, 𝑃 < 0.05).
3. Results The cross-sectional study included 201 individuals diagnosed with HIV, who had since been receiving ART at the Regional Hospital at Wa in the Upper West Region of Ghana between 2003 and 2012. The patients’ demographic and clinical data are presented in Tables 1 and 2. The age range of patients was 20–74 years with the mean ± standard deviation of the age
ISRN AIDS
3 Table 1: Patient demographics relative to medication adherence.
Parameter Missed medications in lifetime Ever missed medications since starting ART Missed medications in the last 6 months Missed medications in the last 3 months Missed medications in the last month Missed medications in the last week Age 20–30 31–40 >40 Sex Male Female Marital status Married Widowed Divorced Single Education No education Primary JHS/middle school SHS Tertiary Family type Nuclear Extended Living alone Monthly income ≤100 101–500 >500 Time since ART (years)
Research Article Predictors of Adherence to Antiretroviral Therapy among HIV/AIDS Patients in the Upper West Region of Ghana Christian Obirikorang,1 Peter Kuugemah Selleh,2 Jubilant Kwame Abledu,3 and Chris Opoku Fofie4 1
Department of Molecular Medicine, School of Medical Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana 2 Department of Medical Laboratory Technology, Faculty of Allied Health, College of Health Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana 3 School of Veterinary Medicine, University of Ghana, Legon, Ghana 4 Ghana Health Service, Upper West Regional Hospital, Wa, Upper West Region, Ghana Correspondence should be addressed to Christian Obirikorang; [email protected] Received 24 September 2013; Accepted 20 October 2013 Academic Editors: R. Ansari and V. C. Bond Copyright © 2013 Christian Obirikorang et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. The effectiveness of ART interventions is only realized in maximal levels of adherence. A near perfect adherence level of >95% is required for the effective suppression of HIV/AIDS virus. The main objective of this study was to identify the sociodemographic and socioeconomic factors that facilitate adherence to antiretroviral therapy among HIV/AIDS patients. Methods. This descriptive cross-sectional study was conducted between March and May 2013 at the Upper West Regional Hospital, Wa. A total of 201 confirmed HIV 1 seropositive subjects (mean age 36.6±9.9 years) receiving antiretroviral therapy were interviewed using a structured questionnaire. The collected data was analyzed using GraphPad Prism version 5. A 𝑃 value of 75%). This
accounts for the increasing number of women being affected worldwide. Homosexual intercourse is the second commonest route of transmission [2]. Sub-Saharan Africa bears the greatest burden with more than two-thirds (68%) of all persons infected with HIV. An estimated 1.8 million adults and children became infected with the disease in Sub-Saharan Africa. It is recorded that out of 260,000 child deaths that occurred globally from HIV/AIDS in 2009, 88% occurred in Sub-Saharan Africa [3]. The HIV/AIDS epidemic in Ghana continues to be a generalized epidemic with a prevalence of more than 1% in
2 the general population. Promising developments have been seen in recent years in global efforts to address the AIDS epidemic, including increased access to effective treatment and prevention programmes [4]. The number of HIV patients receiving ART in Ghana increased more than 200-fold from 197 in 2003 to over 45,000 in 2010. Some regions report ART enrollment lower than their percent share of number of HIV infected persons in the country [5]. The world Health Organization recommendations on the use of ART in resource-limited settings recognize the critical role of adherence in order to achieve clinical and pragmatic success. Good adherence to ART is necessary to achieve the best antivirological response, lower the risk that drug resistance will develop, and reduce morbidity [6]. Combination therapies of ARV drugs are the treatment of choice in HIV, and nonadherence is a major, if not the most important, factor in treatment failure and the development of resistance. 100% medication adherence is paramount for the effective management of HIV [2] and provision of free treatment without adequate patient preparation and adherence support may compromise the success of ART scale-up programmes [7]. A major concern with scaling up of antiretroviral therapy (ART) in resource-limited settings is the emergence of drug resistant viral strains due to suboptimal adherence and the transmission of these resistant viral strains in the population [7]. In view of the changing trend in prevalence of HIV in Ghana and the lack of data surrounding medication adherence in this population, this study therefore proposed to assess the level of and validate (using CD4 results) selfreported adherence and its predictors among patients attending the HIV Clinic of Upper West Regional Hospital, Wa.
2. Materials and Methods This descriptive cross-sectional study was conducted at the Upper West Regional Hospital situated in the southern part of the capital Wa. It is the only specialized referral hospital in the region and the HIV unit currently provides service to over 1600 registered HIV/AIDS patients on antiretroviral drugs. The study was conducted between the months of March and May 2013. A total of two hundred and one (201) confirmed HIV 1 seropositive subjects receiving antiretroviral therapy were interviewed using a structured questionnaire with both open and close ended questions. Primary data was also obtained from their medical records after obtaining permission from the health facility administrators and consent from patients. The Committee on Human Research, Publications and Ethics, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, gave ethical approval for the study to be conducted. Confidentiality, anonymity, and privacy were guaranteed. 2.1. Data Collection. A structured questionnaire which was developed from different literatures was used for the data collection. The dependent variable was adherence to highly active antiretroviral therapy (HAART) among PLWHA. The independent variables were sociodemographic (age, sex, weight, level of education, occupation, marital status, and
ISRN AIDS family type), socioeconomic variables (income), psychosocial (social support, active substance and alcohol use, disclosure of HIV serostatus, and perception of well-being), disease characteristics (duration of HIV infection), regimen related variables (types of ART, dietary related demands/restriction, and side effect), CD4 at diagnosis and current value, followups, adherence to treatment information and symptoms associated with treatment. Many researchers who have conducted studies in this area found that there is no existing gold standard by which adherence can be quantified and many predictors have been reported to influence it. The study therefore chose five measurement tools to quantify adherence from self-recalled report data collected from participants at exit face-to-face interviews: (A) lifetime self-recall adherence, (B) last 6 months’ self-recall adherence, (C) last 3 months’ self-recall adherence, (D) last month’s self-recall adherence, (E) last week’s self-recall adherence. Participants were asked if they had ever missed medication in their lifetime beginning from the time s/he was put on antiretroviral therapy. Self-reported adherence was classified as “adherent” when not a single dose was missed or nonadherent if the patient admitted having missed at least one dose. They were asked about adherence to medication since initiation of ART as listed above. This means that patients’ memory of medicine intake was likely to be good. However, in such face-to-face interviews patients might feel ashamed to report missed medications. Hence participants were assured of confidentiality for their response and they were made aware that, even though medically precarious, every individual could miss medication for one reason or the other. 2.2. Data Management and Analysis. Data collected was sorted, coded, and entered into an Excel spreadsheet for analysis using GraphPad Prism for Windows version 5.0 (GraphPad Software, San Diego, CA, USA). Descriptive statistics such as mean, frequencies, and percentages were used to summarize the data. Overall lifetime adherence to medication was determined from the data and predictors determined. Analysis of contingency tables was done and Fisher’s exact test and the chi-square test were used where necessary to compare proportions. Logistic regression analysis was used to determine the relationships between adherence and other variables (level of significance, 𝑃 < 0.05).
3. Results The cross-sectional study included 201 individuals diagnosed with HIV, who had since been receiving ART at the Regional Hospital at Wa in the Upper West Region of Ghana between 2003 and 2012. The patients’ demographic and clinical data are presented in Tables 1 and 2. The age range of patients was 20–74 years with the mean ± standard deviation of the age
ISRN AIDS
3 Table 1: Patient demographics relative to medication adherence.
Parameter Missed medications in lifetime Ever missed medications since starting ART Missed medications in the last 6 months Missed medications in the last 3 months Missed medications in the last month Missed medications in the last week Age 20–30 31–40 >40 Sex Male Female Marital status Married Widowed Divorced Single Education No education Primary JHS/middle school SHS Tertiary Family type Nuclear Extended Living alone Monthly income ≤100 101–500 >500 Time since ART (years)
