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FACTORS ASSOCIATED WITH ADHERENCE TO ANTIRETROVIRAL THERAPY AMONG PEOPLE LIVING WITH HIV/AIDS ATTENDING FEDERAL MEDICAL CENTRE, GUSAU, ZAMFARA STATE.
CHAPTER ONE
INTRODUCTION
1.1 Background
The human immune deficiency virus (HIV) infection epidemic continues to spread in the population making HIV one of the most important public health crises in the world. Globally, 35.0 million people were living with HIV at the end of 2013. An estimated 0.8% of adult aged 15-49 years worldwide were living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. Sub-Saharan Africa remains most severely affected with nearly one in every 20 adults (4.9%) living with HIV and accounting for nearly 70% of the people living with HIV world wide. Many African countries are experiencing generalized epidemic (national HIV prevalence of more than 1%). But, among those countries with generalized epidemics, a combination of behavior changes, including reductions in numbers of sexual partners, increased condom use, and delayed age of first sex, have reduced new infections (incidence). HIV incidence in urban Zimbabwe fell from an extremely high peak of almost 6% in 1991 to less than 1% in 2010. The vast majority of people newly infected with HIV in subSaharan Africa are infected during unprotected heterosexual intercourse (including paid sex). Having unprotected sex with multiple partners remains the greatest risk factor for
HIV in this region. Large proportions of people living with HIV are in long-term relationships—62% in Kenya and 78% in Malawi. And there are two approaches to reduce the epidemic: preventing new HIV infections and providing antiretroviral treatment to people who need it. Nigeria, with about 2% of the world’s population, accounts for about 10% of people living with HIV (PLWHIV) globally with an estimated 3.3 million PLWHI Of these, about a million are eligible for antiretroviral therapy (ART). The government with
support of several partners such as global health initiatives, e.g., the United States (US) President`s Emergency Plan For AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFTAM) has rapidly scaled up ART enrollment and
has steadily increased number of patients initiated on ART from 90,008 in 20064 to an estimated 300,000 at the end of 2009. Antiretroviral (ARV) drugs have to be taken as a lifelong therapy and their success relies on continual adherence to the medication
regimen. A rate of adherence of approximately 95% is required to avoid rapid development of drug resistance and treatment failure.7
Treatment adherence is defined as the extent to which a person currently takes prescribed medication. It is widely agreed that in order to achieve an undetectable viral load and prevent the development of drug resistance, a person on ARV drugs need to take at least
95% of prescribed doses on time.8,9 There is no gold standard to measure adherence, commonly used method includes: patient self-report, pill count, pharmacy refill records, drug level monitoring, and physician assessment. Patient self report is the most common
method of adherence assessment. 6,8,9,10 Patient self-report has proven reliable since the estimation of CD4 cell count and viral load in some of the studies11 correlated well with the high adherence to drug therapy achieved. Drug level monitoring and electronic drug
monitoring methods of measurement are not commonly used in adherence studies in developing countries because they are expensive, technically difficult, and require laboratory testing and training of personnel. Even studies in advanced countries in North America and Europe where these methods are utilized more often, studies still shows a large dependence on patient self report
FACTORS ASSOCIATED WITH ADHERENCE TO ANTIRETROVIRAL THERAPY AMONG PEOPLE LIVING WITH HIV/AIDS ATTENDING FEDERAL MEDICAL CENTRE, GUSAU, ZAMFARA STATE.
