Adherence to Antiretroviral Therapy among HIV/AIDS in Federal Medical Centre, Owerri

The research is set out to determine the adherence to antiretroviral therapy among HIVAIDS in Federal Medical Clinic Owerri. The purpose of the study was to assess patients knowledge of benefits of Highly Active antiretroviral Regimen, determine level of adherence among the HIV patients, identify factors affecting adherence to antiretroviral regimen among HIV patients, relationship between adherence antiretroviral therapy and basic demographic factors like level of education and gender . Related literature was reviewed. The research design used was a descriptive survey design. The instrument for the study was a validated and reliable questionnaire (r-0.82). A reliable and validated questionnaire was used as the major instrument for data collection. The findings indicated that 169 (88.0%) of the respondents have a high knowledge of the benefits of antiretroviral therapy while 23 (12.0%) of the sample have low knowledge. In other words, a large number of the sampled populations are well aware of the benefits of antiretroviral therapy. Conclusion was drawn that a large number of the sampled population are well aware of the benefits of antiretroviral therapy. Recommendations made were that the clinician should emphasize reducing adverse drug reaction, detecting and treating co-morbidities early, improving knowledge through health education, and encouraging the patients to disclose their HIV status to their families. Also Intensive adherence counseling should be provided to all patients before initiation of antiretroviral therapy. Health care providers must identify possible barriers to adherence to HIV/AIDS antiretroviral therapy and provide appropriate solution. Original Research Article Vincent et al.; JPRI, 33(57A): 360-368, 2021; Article no.JPRI.78973 361


INTRODUCTION
The introduction of antiretroviral treatment (ART) has reduced morbidity and mortality among people living with HIV. The scaling up of antiretroviral treatment was a critical turning point in the clinical management of the HIV/AIDS disease and the gradual evolution of HIV infection into a chronic non-fatal condition. By restoring the immune function and suppressing the virus to an undetectable level. This resulted in preventing the transmission of the virus to other uninfected individuals.
Over the past decade, there has been an unparalleled effort to provide access to antiretroviral therapy (ART) for HIV-infected individuals through Global Fund, World Bank and US Presidents Emergency plan for AIDS relief (PEPEAR) [1]. The effectiveness of antiretroviral therapy relies in a strict adherence to it. In other words, loose obedience or non-obedience to ART can result in inadequate rural suppression failure, rapid diseases properties and development of drug resistance. Antiretroviral therapy (ART) provides the only viable remedy to manage and reduce the health crises posed by the infection in sub-Sahara Africa. The benefits associated with adhering to ARVs are recovery of immunity hence ability to fight opportunistic infections, improved quality of life allowing patients to become strong and healthy and able to get back to work. Also ARVs are associated with delay in disease progression to AIDS, reducing viral load and decline in morbidity and mortality in people living with HIV. On the other hand suboptimal adherence is associated with treatment failure, viral mutation and development of drug-resistance HIV. Many reports have linked non-adherence to antiretroviral treatment as a major challenge to successful management of patients with HIV/AIDS. Non-adherence to antiretroviral treatment has been a critical issue in addressing the menace of HIV/AIDS globally. It is estimated that adherence rates of 90% or more generally need to be obtained to achieve virologic success [2]. Hence, after availability of HIV medication, a key-challenge is to promote adherence and retention in care in order to obtain optimal treatment outcomes for the patient. This study explores adherence to antiretroviral therapy among HIV/AIDS in Federal Medical Clinic Owerri.

Purpose of the Study
The purpose of this study will be to determine the adherence to antiretroviral therapy among HIV/AIDS in Federal Medical Clinic Owerri.

Research Design
The descriptive survey design was employed for this study.

Area of the Study
The study focused on HIV/AIDS in Federal Medical Center Owerri.

Sampling Techniques and Sample size
The sample size was determined for a limited population using Yaro Yamane's statistical formular as follows: Hence a total of 191 patients were chosen as sample

Sampling Procedure
A simple random sampling was used to select respondents for the study. The respondents were stratified patients from six different wards. For the patients, 4 wards were selected using random sampling method and the duty roaster of each ward was used as the sampling frame. The number of the patients in the duty roaster was copied out and written on pieces of paper. This was placed in a basket and shuffled and for each ward 48 patients were selected making a sum of 192 patients.

Methods for data collection
The instrument for the collection of data was structured questionnaire which was personally constructed because it has the advantage of giving the respondent enough time to study and give realistic response to the question items. The questionnaire consists of two question items on the respondents' demographic data. While section B consists of twenty items that are divided into five (5) parts. Each cluster contains some items which were systematically presented according to five (5) research questions.

Validity of the method
The self-structured questionnaire was validated by three lecturers in the department of Nursing Science, Open University after the vetting by the supervisor. This was done to ascertain the appropriateness of the instrument in relation to adherence to antiretroviral therapy among HIVAIDS in Federal Medical Clinic, Owerri, objectives and research questions. Their criticism and modifications were used to produce the final copy of the instrument.

Reliability of the Instrument
The reliability of the instrument was determined through test re-test method. Twenty (20) copies of the instrument was administered to patients in Imo State Teaching Hospital which was not the area selected for the study. After two weeks, the same 20 copies of the instrument were readministered to the same people. This is a testretest technique and the essence is to ascertain the strength and weakness of the instrument. The test results were tallied and analyzed using with Spearman Brown Rank order correlation coefficient. The correlation coefficient of 0.82 was gotten which shows that the instrument was reliable.

Method of Data Collection
The systematically sampled patients were reached in their wards and the questionnaire administered to them by the researcher was by face to face. It was filled on the spot and returned.

Method of Data Analysis
The duly completed copies of the structured questionnaire were collected, coded and analyzed using descriptive statistics of frequency count and percentages.

RESULTS
In this chapter, the results of data collected are arranged and presented.        In summary, the result shows that patients with secondary and tertiary education have high adherence more than respondents who have no formal education and primary education.
Data in Table 7 shows the chi square analysis showing the influence of gender on strict adherence to ART. The x 2 calculated value is given as 1.81 with an associated p-value of .404 (p>.05) which is greater than the 0.05 level of significance. Since p >.05, the null hypothesis is not rejected which implies that gender does not significantly influence strict adherence to ART therapy. Literally speaking, respondents' adherence to ART therapy is not based on their gender. table 8 shows the chi square analysis showing the influence of level of education on strict adherence to ART. The x 2 calculated value is given as 26.48 with an associated p-value of .00 which is less than the 0.05 level of significance. Since p<.05, the null hypothesis is rejected which implies that respondents' level of education significantly influencesstrict adherence to ART therapy. Literally speaking, respondents' adherence to ART therapy is influenced by their level of education. Table 9 shows the chi square analysis showing the influence of knowledge of benefits of ART on strict adherence to ART. The x 2 calculated value is given as 13.01 with an associated p-value of .001(p<.05) which is less than the 0.05 level of significance. Since p<.05, the null hypothesis is rejected which implies that respondents' knowledge of benefits of ART significantly influences strict adherence to ART therapy.

Data in
Literally speaking, respondents' adherence to ART therapy is greatly influenced by their level of knowledge on the benefits of ART therapy. Findings from research question two revealed that 175 (91.1%) of the respondents strictly adhere to ARK therapy while only 17 (8.9%)) have either moderate or low adherence. The reason for this finding could be the awareness on the benefits of the ART therapy which is often given to HIV/AIDS patients. This finding is however debunked by the findings of Tocco [4] who reported a very low level of adherence to antiretroviral therapy among newly treated people living with HIV in University of Gondar Ethiopia.

DISCUSSION
Findings from research question three revealed that the major factors affecting adherence to antiretroviral regimen according to the respondents include: running out of drugs (this was agreed on by 98.4% of the respondents), and depression (agreed by 82.8% of the respondents. This finding is buttressed by that of Wasti et al. [5] who reported in their study factors affecting adherence to ART therapy among HIV patients in Nairobi that the major factors affecting adherence to ART among pregnant HIV women were running out of drugs, forgetfulness and depression. They further recorded that depression was a major factor which plunged HV/AIDS patients into forgetfulness which in turn leads to loss in keeping track of drugs.
Findings revealed that 93.5% of males strictly adhere to ART regime while 88.1% of the sample female strictly adheres to ART regimen. The results showed that males strictly adhere to ART regime more than females although the difference is very small.
Results from analysis of hypothesis one revealed the association between gender and adherence to ART regimen in FMC Owerri. The results gave a chi-square computed p-value of .404 which is greater than 0.05 level of significance implying a non-significant association. There is no statistically significant association between gender and HIV/AIDS patients' adherence to ART regimen in FMC Owerri. This implies that although a higher percentage of males adhered more strictly than the females, the gap between their extents of adherence is not significant enough to establish a difference. On the other hand, a statistically significant association was found between patients' level of education and their level of adherence to ART therapy. The p-value was given as p=.000 indicating a significant association.
Results from analysis of hypothesis two revealed the influence of knowledge of the benefits of ART therapy on HIV/AIDS patients' adherence to ART in FMC Owerri. The results gave a chisquare computed p-value of .001 which is less than 0.05 level of significance implying a significant influence. This by implication means that knowledge of the benefits of ART therapy significantly influences patients' adherence to the therapy in FMC Owerri. In other words, higher knowledge of the benefits of ART produces stricter levels of adherence to the therapy and vice versa. Reason for this finding cannot be far-fetched as anything which has life saving benefits is prone to be embraced among the living [6][7][8][9][10][11].

CONCLUSION
A large number of the sampled populations are well aware of the benefits of antiretroviral therapy. Depression and forgetfulness was among the major factor which plunged HIV/AIDS patients. Knowledge of the benefits of ART therapy significantly influences patients' adherence to the therapy. Patients' level of education influences patients' adherence to the therapy.

CONSENT AND ETHICAL APPROVAL
Informed consent was gotten from the participants and ethical clearance got from ethical committee of Federal Medical Center Owerri.