Patient's adherence to antiretroviral therapy in Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria
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Date
2013-02
Authors
Aderemi-Williams, R.I.
Journal Title
Journal ISSN
Volume Title
Publisher
School of Postgraduate Studies of the University of Lagos, Akoka
Abstract
Evidence abound that successful management of HIV and AIDS using Highly Active
Antiretroviral Therapy (HAART) requires not less than 95% adherence. Longitudinal studies
measuring adherence using four different tools have not been documented in Africa. The use
of different tools to determine and predict factors that may affect adherence in Nigeria has
not been documented to the best of our knowledge.
A study (comprising of 3-month retrospective and 45-month prospective) was carried out in
Lagos State University Teaching Hospital (LASUTH) between December, 2006 to December,
2010. Validated questionnaires and monitoring of patients’ clinical progress were used.
Adherence was assessed using self-report, unannounced pill counts, doctor’s appointment
attendance, and pharmacy refill record. Patients with 95% and above adherence levels were
considered adherent. Data collected from 248 of the 294 (84.35%) patients eligible for the
study were analysed. ANOVA was used to compare and determine the adequacy of the
adherence assessment tools. Predictors of adherence were determined with logistic regression
models and paired sample t-test was used to test effect on patients’ CD4 count.
Social and clinical demographic data analysis of study patients show that 134 (54.00%) were
married, 58 (23.40%) were single; 148 (59.70%) females, 100 (40.30%) males; 211 (85.10%)
were Christians, 31 (12.50%) were Muslims; 106 (42.70%) had secondary school education,
67 (27.00%) had tertiary education, 43 (17.3%) had primary education and 139 (56.05%)
were employed. Their mean age was 40.39 ±8.78 years and mean baseline CD4 cell count
was 143.46 ±92.72 cell/μL. At baseline, 66.10% of the patients were on 12- hourly regimen
while 33.90% were on 24-hourly regimen.
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Unannounced pill count (mean = 96.97±6.02) measure was found to be the best measure for
patient’s adherence, followed by pharmacy refill (mean = 96.64±6.95), self-report (mean =
95.26±15.51) and doctor’s appointment attendance (mean = 74.70±14.93) measure.
None of the variables studied was a predictor of adherence using self-report as a measure of
adherence. Using unannounced pill counts: younger age (18-39 years), being Muslim and
patients’ knowledge of transmission were predictors of adherence. In
doctor’s appointment attendance measure of adherence; knowledge of management,
knowledge of adherence, knowledge of HIV pathogenesis and patients’ habits predicted
adherence.
The following are predictors of adherence when measured with pharmacy refill record:
marital status, Muslim religion, tertiary education, being a professional, skilled worker,
knowledge of drug management, knowledge of adherence and presence of social support.
The effect of highly active antiretroviral therapy (HAART) on improving the immunological
status of patients was significant.
Adherence was dynamic over the study period. The study was also able to identify many
possible predictors of adherence with pharmacy refill record identifying most predictors. Due
to identified gaps in patients’ CD4 count monitoring, the difference in immunological status
between adherent and non-adherent patients was not significant
Description
A thesis submitted to University of Lagos, Akoka, in partial fulfillment of the requirement for the award of Doctor of Philosophy in Clinical Pharmacy
Keywords
Antiretroviral Therapy (HAART) , HIV & AIDS , Nigeria , Patients , Logistic regression models , Research Subject Categories::PHARMACY
Citation
Aderemi-Williams, R.O. (2013). Patient's adherence to antiretroviral therapy in Lagos State University Teaching Hospital (LASUTH), Ikeja, Lagos, Nigeria. A thesis submitted to University of Lagos, Akoka, in partial fulfillment of the requirement for the award of Doctor of Philosophy in Clinical Pharmacy, 178p.