FACTORS ASSOCIATED WITH ADHERENCE TO ANTI-RETROVIRAL DRUGS AMONG PATIENTS ACCESSING CARE AT NIGERIA INSTITUTE OF MEDICAL RESEARCH LAGOS, NIGERIA.

FACTORS ASSOCIATED WITH ADHERENCE TO ANTI-RETROVIRAL DRUGS AMONG PATIENTS ACCESSING CARE AT NIGERIA INSTITUTE OF MEDICAL RESEARCH LAGOS, NIGERIA.

CHAPTER ONE
INTRODUCTION
1.1 Background
Joint United Nation Program for HIV/AIDS estimated that between 31.4 million and 35.9 million people are currently living with HIV/AID worldwide of which 4.8 million are in Asia (China;78 0,000, Thailand; 490,000 and Indonesia; 380,000), 490,000 in Latin
America (Brazil; 490,000), 2.3 million in North America, Western and Central Europe, 1.3 million in USA, 53,000 in Oceania, 230,000 in Caribbean, 300,000 in Middle East and North Africa and 23.5 million in Sub-Sahara Africa (Tanzania; 1.6 million, South Africa; 5.6 million, Uganda; 1.4 million, Zambia; 970,000, Zimbabwe; 1.2 million, Kenya; 1.6 million, Ethiopia; 790,000 and Nigeria; 3.1 million). The number of AIDS-related death was reported to be 1.7 million and 2.5 million were due to new infections. Out of 14.8
million persons eligible for HIV treatment, only approximately 54% are on ARV treatment.In the last ten years (2001-2011) the landscape of national HIV epidemics has changed dramatically, for the better in most countries, especially in sub-Saharan Africa where 69% of HIV/AIDS cases live. Countries are making historic gains towards ending the AIDS epidemic: 700 000 fewer new HIV infections across the world in 2011 than in 2001.1 Nigeria with estimated population of 173, 611, 131 and growth rate of 3.2% 2,3
has a current HIV prevalence of 4.1% with about 3.2 million infected with the virus and estimated 1.6 million eligible for Anti-retroviral drugs. With estimated 34% of the general population accessing basic health care, the epidemic is more ravaging in the rural areas, which compounds the issue of accessibility to comprehensive HIV/AIDS services located in the urban settings.Federal Government, as part of its care and support strategies initiated the National Antiretroviral Drug Access Programme in 2002 in 25 tertiary sites across the country, and was subsequently scaled up to more sites in succeeding years with support from
Presidential Emergency Plan for AIDS Relief (PEPFAR), United States agency for International Development (USAID), Global Fund Round 5, 8 & 9, World Bank, UN Agencies and fund from Millennium Development Goals (MDGs). Implementation of the
programme was facilitated and guided by a committee set up by the Federal Government of Nigeria.The predominant model for HIV/AIDS Care and support is a „hub and spoke‟ model which encourages seamless networking between different levels of Health facilities and non-medical resources. 4,5 The tertiary health centres which serve as „hubs‟ provide specialized clinical care, mentoring and technical oversights to the secondary health centres which are considered as „spokes‟. In line with the model, the spokes are expected to receive referrals from feeder sites that constitute the Primary Health Care (PHC) centres. However, with the renewed efforts and commitment by Federal Ministry of Health and its stakeholders to avail and increase access to HIV/AIDS services to the
patients in rural communities, and to decongest the overburdened tertiary health facilities, the Ministry adopted the concept of decentralization of ART services to the PHCs, where some facilities now offer pick-up of ARV drugs by PLHIV and others initiate ART for naïve patients. Adherence monitoring among large number of HIV/AIDS patients in most ART centres in Nigeria is a major concern to achieving ART programme success. There is limited manpower to deal with adherence challenge at individual patient level. Previous studies revealed that adherence among PLHIV in Nigeria and other Africa countries ranges from 55-85%,(6) which is below the expected of greater or equal to 95%. Poor adherence (<95%) is found to be an issue among patients on ART irrespective of sex, age, socioeconomic status and the health facility.Poor adherence (< 95%) leads to rise in viral load and reduction in CD4 count leading to
increase in morbidity and mortality among patients on ART with ultimate poor clinical outcomes and failure in the entire national ART programme. In addition, poor adherence to ART results in low survival, clinical, immunological and virological response for
patients. Adherence to ART is one of the very important factors which determine treatment success and occurrence of viral resistance.
The need for near perfect adherence to lifelong antiretroviral therapy (ART) during treatment is a major challenge in the administration of highly active anti-retroviral therapy (HAART) to HIV infected patients. Appropriate use of antiretroviral therapy (ART) has improved the health of many human immunodeficiency virus (HIV) positive individuals who otherwise may have died.
Notably, the efficacy of any treatment depends on sustained high levels of adherence to ART.

FACTORS ASSOCIATED WITH ADHERENCE TO ANTI-RETROVIRAL DRUGS AMONG PATIENTS ACCESSING CARE AT NIGERIA INSTITUTE OF MEDICAL RESEARCH LAGOS, NIGERIA.