The Human Immunodeficiency Virus (HIV) epidemic remains a major global public health problem, with sub-Saharan Africa (SSA) at its epicentre. Despite the use of antiretroviral therapy (ART) to reduce new infections and deaths, SSA reports the highest HIV incidence, constituting two-thirds of global new infections. Cameroon is one of SSA countries where HIV care decentralization is enforced as a national policy but follow up of people living with HIV (PLWH) is provider-oriented, with limited patient involvement in clinical monitoring. The purpose of this dissertation was to explore predominant barriers and facilitators influencing ART adherence and identify effective interventions enhancing ART adherence across SSA. Furthermore, we sought to assess the prevalence and predictors of ART non-adherence among PLWH, and factors influencing non-adherence among PLWH who have experienced ART non-adherence in Cameroon.
We conducted a comprehensive systematic review and meta-analysis on studies examining barriers to ART adherence and interventions boosting adherence. Forty-five studies were selected (30 for narrative synthesis and 15 for meta-analysis). Identified barriers and facilitators to ART adherence were categorized into seven principal factors: patient-related, health system-related, medication-related, stigma, poor mental health, socioeconomic and socio-cultural-related factors. Adherence-enhancing interventions encompassed counselling, incentives, mobile phone short message service, peer delivered behavioral intervention, community ART delivery, electronic adherence service monitoring device, lay health worker lead group intervention and food assistance. The meta-analysis revealed a statistically significant difference in ART adherence between intervention and control groups (pooled OR=1.56, 95%CI:1.35 - 1.80, p=<0.01).
Using a cross-sectional study of adult PLWH in HIV treatment centres in Cameroon, we explored the prevalence and predictors of ART non-adherence. A total of 451 participants with mean age 43.42 years (SD: 10.42), were enrolled. Overall, ART non-adherence was 37.78%. Reasons for missing ART include forgetfulness, business and traveling without drugs. Significant factors associated with ART non-adherence include age, education, and alcohol consumption.
In a qualitative study of 43 adult PLWH who had experienced ART non-adherence, adherence barriers included those related to patient, medication, health service, stigma, use of alternative treatment, resource limitation, environmental/social, and political instability. Adherence facilitators included social support, aligning treatment with patient’s daily routines, use of reminders, health sector/caregiver support, and awareness of HIV status/ART knowledge.
To harness full potential of ART and mitigate HIV burden in SSA countries, stakeholders engaged in HIV management must recognize and integrate barriers, facilitators, and adherence-enhancing interventions when formulating policies or crafting treatment strategies. Continuous information provision and unflinching support both from patients’ families and caregivers are needed to improve adherence. Future studies focusing on specific underrepresented demographics - HIV-infected children, adolescents, and pregnant women in SSA are needed to uncover appropriate barriers, facilitators and interventions tailored to each group’s unique needs. Other studies focusing on assessing long-term non-adherence trends and determinants using larger samples of PLWH in many regions are necessary. Also, studies using both in-depth and focused group discussions, and quantitative approaches are required to uncover the ART non-adherence-related burden.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/45907 |
| Date | 01 February 2024 |
| Creators | Buh, Amos Wung |
| Contributors | Phillips, Karen Patricia, Yaya, Sanni |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
| Rights | Attribution-NoDerivatives 4.0 International, http://creativecommons.org/licenses/by-nd/4.0/ |
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