Factors associated with anti-retroviral therapy (ART) adherence among adult people living with HIV (PLWH): A 5-year retrospective multi-centre study in Kumasi, Ghana

Ebenezer Senu; Samuel Asamoah Sakyi; Nana Kwame Ayisi-Boateng; Anthony Kwame Enimil; Stephen Opoku; Richard Owusu Ansah; Bismark Dankwah Aning; Diana Atsieno Ojuang; Doreen Nafula Wekesa; Fatima Osman Ahmed; Chidinma B Okeke; Ama Darkoaa Sarfo; Gabriel Sakyi Kwofie; Benjamin Amoani

doi:10.1016/j.dialog.2022.100082

Factors associated with anti-retroviral therapy (ART) adherence among adult people living with HIV (PLWH): A 5-year retrospective multi-centre study in Kumasi, Ghana

Dialogues Health. 2022 Nov 21:1:100082. doi: 10.1016/j.dialog.2022.100082. eCollection 2022 Dec.

Authors

Ebenezer Senu^{1

2}, Samuel Asamoah Sakyi¹, Nana Kwame Ayisi-Boateng³, Anthony Kwame Enimil⁴, Stephen Opoku^{1

2}, Richard Owusu Ansah², Bismark Dankwah Aning², Diana Atsieno Ojuang², Doreen Nafula Wekesa², Fatima Osman Ahmed², Chidinma B Okeke², Ama Darkoaa Sarfo², Gabriel Sakyi Kwofie⁵, Benjamin Amoani⁶

Affiliations

¹ Department of Molecular Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
² Department of Medical Diagnostics, Faculty of Allied Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
³ Department of Medicine, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
⁴ Pediatric Infectious Disease Unit, Child Health Directorate, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
⁵ Living Waters Hospital, Kumasi, Ashanti region, Ghana.
⁶ Department of Biomedical Science, School of Allied Health Sciences, University of Cape Coast, Cape Coast, Ghana.

Abstract

Background: Combined antiretroviral therapy (cART) is the recommended treatment regimen for people living with HIV (PLWH). Long-term HIV treatment of over 95% adherence inhibits increase in viral load and boosts immune system performance. On the contrary, non-adherence results in treatment failure, accelerated development of HIV drug-resistance and increased mortality. However, there is paucity of data on the prevalence of antiretroviral therapy (ART) adherence and its associated factors in Ghana. We assessed the prevalence, sociodemographic and clinical factors associated with ART adherence among registered PLWH.

Methods: In a multi-centre hospital-based retrospective study, we collected data on 720 registered PLWH 18 years and above, who attend the HIV clinic at the University Hospital (KNUST), Komfo Anokye Teaching Hospital (KATH), and the Bomso Clinic, on ART and with up-to-date medical records. They were enrolled using a multistage sampling technique. Adherence was assessed retrospectively using missed doses and prescriptions renewal. All analysis were done using SPSS Version 26.0 and GraphPad prism version 8.0.

Results: Of 720 registered PLWH, 51.8% had good ART adherence, 35.3% had fair ART adherence and 12.9% had poor ART adherence. Those diagnosed at WHO stage II (aOR = 0.45, 95% CI: (0.30-0.68); p < 0.0001) and stage III (aOR = 0.40, 95% CI: (0.27-0.59) < 0.0001) were independently associated with lower chances of good adherence to ART. Moreover, those treated with AZT/3TC/EFV (aOR = 0.33, 95% CI: (0.16-0.68); p = 0.0030), and AZT/3TC/NVP (aOR = 0.50, 95% CI: (0.26-0.98); p = 0.0410) were independently associated with lower likelihood of good ART adherence. On the contrary, PLWH who have been on treatment for 4 years (aOR = 3.56, 95% CI: (1.10-11.54); p = 0.0340) was an independent predictor of good ART adherence.

Conclusion: About half of PLWH on treatment have good adherence to ART. Being diagnosed at WHO stage II and stage III, being treated with AZT/3TC/EFV, and AZT/3TC/NVP ART combination are associated with lesser chances of good ART adherence. However, increased duration of ART among PLWH influence good ART adherence. PLWH on ART should be monitored to achieve over 95% ART adherence for effective management of HIV/AIDS.

Keywords: Adherence; Anti-retroviral (ARV); Anti-retroviral therapy (ART); HIV/AIDS; Treatment; WHO stage.