Predictors of non-adherence to antiretroviral therapy among HIV patients in secondary health care facilities in Kano State- Nigeria: a case-control study.

Introduction: Treatment success requires both a sustainable supply of Antiretroviral Therapy (ART) to clinics and lifelong adherence to treatment by patients. Poor adherence to medication may lead to treatment failure as a result of developing HIV resistance strains. Based on WHO 2014 guideline, over 26 million people will be additionally enrolled globally. Optimal treatment requires identification of patients with suboptimal adherence for targeted intervention. The aim of the study was to determine the predictors of non-adherence to ART.

Methods: An unmatched 1:2 case-control study with 68 cases using simple random sampling. A case was defined as an ART patient who failed to achieve increase in CD4 count of 100cell/mm in one year. Controls are those with adequate immunological response. Questionnaires were administered for socio-demographic and adherence-related information. Bivariate and multivariable logistic regression was done using Epi Info at 95% Confidence Interval (CI) and precision of 5%.

Results: A total of 204 patients were enrolled, mean age of cases was 36 (Standard Deviation Sd=8.8), n=68 and controls 37 (Sd=9.8), n=136. Of enrollees, 69.6% (142) were females. Mean duration on ART was 4.9 years for cases and 4.5 years for controls (standard deviation = ± 2.2 years). The commonest reason for missing drugs was forgetfulness (58% cases). On multivariate analysis, having formal education (Adjusted Odds Ratio [aOR] = 3.03, 95% CI = 1.5-6.0) and income above minimum wage, (aOR = 2.38, 95% CI = 1.06-4.76) were independently associated with non-adherence. The commonest reason for missing drugs was forgetfulness (58% cases).

Conclusion: In conclusion, educated people and those with higher income were more likely to be non-adherent and should be the focus of adherence counseling. Some form of reminders like use of telephone should be adopted to address forgetfulness.