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Health Policy and Planning Advance Access published online on March 10, 2009
Health Policy and Planning, doi:10.1093/heapol/czp006
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Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2009; all rights reserved.

Determinants of non-adherence to subsidized anti-retroviral treatment in southeast Nigeria

B S C Uzochukwu1,*, O E Onwujekwe2, A C Onoka3, C Okoli4, N P Uguru5 and O I Chukwuogo3

1 Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria.
2 Department of Health Administration and Management, College of Medicine University of Nigeria, Enugu, Nigeria.
3 Department of Community Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria.
4 Health Policy Research Group (HPRG), College of Medicine, University of Nigeria, Enugu, Nigeria.
5 Department of Preventive Dentistry, College of Medicine, University of Nigeria, Enugu, Nigeria.

* Corresponding author. Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria, P.O. Box 3295 Enugu, Nigeria. Tel: +234-80-3313-0050. E-mail: bscuzochukwu{at}yahoo.com

The anti-retroviral (ARV) treatment programme in Nigeria is delivered through selected teaching and mission hospitals at a free/subsidized rate. The government aims to scale up ARV treatment in the country. However, non-adherence to ARV medication can lead to viral resistance, treatment failure, toxicities and waste of financial resources. This study examined the factors responsible for non-adherence to free/subsidized ARV treatment in south-east Nigeria.

The study was cross-sectional and descriptive. Information was collected from 174 patients selected by simple random sampling from the register of all patients who had been on anti-retroviral therapy (ART) for at least 12 months at the beginning of the study period. Patients were identified during their clinic visits. Information on their socio-demographic profile, ARV treatment and determinants of non-adherence to ARV treatment was obtained from those who gave consent, using pre-tested interviewer-administered questionnaires.

All patients clearly understood the need to take ARV drugs throughout their lives, and what the costs entailed. They understood the need for periodic testing, the probability that complications would develop, cost of transportation to treatment site and the daily treatment regimen. Seventy-five per cent of respondents were not adhering fully to their drug regimen; the mean number of days that respondents had been off drugs was 3.57 days the preceding month. Reasons for non-adherence included: physical discomfort (side effects); non-availability of drugs at treatment site; forgetting to carry drugs during the day; fear of social rejection; treatment being a reminder of HIV status; and selling of own drugs to those unable to enrol in the projects. Being female, under 35 years, single, and having higher educational status were significantly associated with non-adherence.

It is important that policy makers and programme managers address the factors responsible for non-adherence when scaling up subsidized ARV treatment in Nigeria and other parts of sub-Saharan Africa.

Key Words: Anti-retroviral therapy, adherence, determinants, compliance, treatment, HIV, AIDS

Accepted for publication 26 November 2008.


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