SUMMARY

HIV/AIDS is a disease of public health importance with about 35 million people worldwide

living with the disease and Sub-Saharan Africa accounting for about 27.7 million cases. Nigeria

has 3.2 million cases and has recorded 210,000 deaths. Control of the disease has been

predicated on prevention and effective ART. For ART to be successful however, adherence rate

of 95% or more is required to be complemented by adult ART coverage of 80%. Nigeria

however, has 40%. Thus, this study aims to identify the determinants of adherence to

antiretroviral therapy among adults with HIV/AIDS in Dalhatu Araf Specialist Hospital, Lafia,

Nasarawa State.

The study was conducted using a descriptive cross sectional design among 426 randomly

selected HIV/AIDS patients (18 years and above) attending ART clinic in DASH, Lafia.

Quantitative data collection technique was used with the administration of a semi-structured

questionnaire by research assistants. Data was analyzed using Statistical Package for Social

Sciences (SPSS) version 20.0 for univariate and bivariate analyses.

Mean age was 35.8 years (SD± 9.6). Of the respondents, 2.6% had less than 95% adherence rate

and forgetfulness (40%) was the commonest reason for non-adherence. The study showed that

70.2% were females, 59.6% were married and 55.2% had educational level lower than secondary

school education. Also, average knowledge HIV, ART, adherence and level of adherence were

determined to be 40.4%, 80.1%, 55.4% and 97.4% respectively. In addition, age, gender, marital

status and level of education were not significantly associated with adherence. It was

recommended that the adherence level be sustained and enlightenment be intensified to curb the

spread of HIV/AIDS.

Key words: HIV/AIDS, Adherence, Antiretroviral therapy, Nigeria

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CHAPTER ONE

INTRODUCTION

1.1 Background

The Human Immunodeficiency Virus (HIV) which causes Acquired Immune Deficiency

Syndrome (AIDS) has continued to be a major global challenge since its discovery in the 1980s

and is said to be the leading cause of mortality in the last decade. Deaths arising from HIV/AIDS

have been estimated to be about 39 million.1

About 35 million people worldwide live with HIV/AIDS. Majority live in low and moderate

income countries in Sub-Saharan Africa accounting for about 24.7 million of people living with

HIV/AIDS.1    Sub-Saharan Africa with a prevalence of 4.7% has South Africa as the worst

affected region. Swaziland has the highest HIV prevalence of any country worldwide (27.4%)

while South Africa has the highest epidemic of any country (5.9 million) .2,3

In Nigeria, about 3.2 million people are living with HIV accounting for about 9% of global

figure. 210,000 deaths have been recorded from AIDS-related illnesses.3 National prevalence of

HIV stands at 3.4% with the highest prevalence being among 35-39 years age group (4.4%) and

the lowest in 15-19 years age group (2.9%).4     Rivers State however has the highest prevalence

among other states with a prevalence of 15.2%.4    The availability of effective anti-retroviral

therapy (ART) to control the virus so that people with HIV can enjoy healthy lives and reduce

the risk of transmission to others has resulted in concerted efforts being made by the global

health community and leading government and civil society organizations in the treatment and

prevention of HIV.3 However adherence to ART by people living with HIV who are eligible is

key.

1

Adherence is described as a patient’s ability to follow a treatment plan, take medications at

prescribed times and frequencies and follow restrictions regarding food and other medications. It

is a collaborative process between the patient and the provider where the patient plays a more

active role in his treatment and makes a commitment to follow the prescribed regimen as best as

possible.5,6-7

Adherence to ART is critical to obtain the full benefits of Highly Active Anti-Retroviral Therapy

(HAART) which include maximal and durable suppression of viral replication, reduced

destruction of CD4 cells, prevention of viral resistance, promotion of immune reconstitution and

slowed disease progression.5,6-7 While an adherence rate of 95% or more is needed to achieve

virologic success, multiple approaches are used to measure adherence as there is no single

method to measure it accurately. Some of the measures used include self report, electronic