SOCIAL SUPPORT AND ADHERENCE TO ANTI-RETROVIRAL THERAPY AMONG HIV PATIENTS IN UNIVERSITY OF PORT-HARCOURT TEACHING HOSPITAL, PORT-HARCOURT, NIGERIA

Abstract

HIV/ AIDS is one of the most challenging pandemic of the 21st century. More than two-thirds of adults infected with HIV live in Sub-Saharan Africa. Adherence to Anti-Retroviral Treatment (ART) is a key factor that determines the success or failure of treatment, while non-adherence is a major cause of HIV drug resistance and subsequent immunological and clinical failure. Social support is a significant resource for individuals undergoing stress, and has been found to improve adherence among patients with chronic illness. The aim of this study was to measure the association between social support and adherence to ART among HIV patients in University of Port-Harcourt Teaching Hospital (UPTH), Port Harcourt. The study was an unmatched 1:1 case-control study with 192 cases and 192 controls carried out among HIV patients attending the Anti-retroviral clinic of UPTH, between May to July 2016. A case was defined as a patient who has taken less than 95% of prescribed dose, while a control was a patient who has taken at least 95% of prescribed dose in the 2 weeks prior to the study. Consecutive patients were tested for adherence using self-report until 192 non-adherent cases were selected. Adherent patients were selected consecutively to make up 192 controls. A five-point questionnaire was used to calculate each client's self-reported adherence. Social support was measured using the Medical Outcomes Study Social Support Survey (MOSSSS). Structured interviewer administered questionnaire was used to collect data on socio-demographic characteristics, knowledge of HIV and its treatment, and on factors influencing adherence. Data was analysed with frequencies, t-test, chi-square and logistic regression with level of significance a<0.05. The mean age of cases and controls were 36.7±9.0 years and 37.5±8.6 years respectively. Females constituted 78.6% of cases and 75% of controls. About half of the cases and controls were married. The mean CD4 count was 476.9 (±274.10) and 499.6 (±290.18) for cases and controls respectively. There were no significant differences in age, gender, marital status and CD4 count, between the cases and controls. The mean adherence rate was 87.2% (± 16.2) for cases and 99.8% (±0.77) for controls (p<0.001). The mean duration of treatment was 57.3 J (±39.0) months for cases and 60.3 (±42.1) months for controls (p=0.463). Poor social support was associated with non-adherence to ART, among patients in lower socio-economic classes III-IV (OR=3.34, CI =I .43 - 7.81). Non-adherence was also associated with Poor emotional support (AOR =4.46; Cl =1.98 - 10.05) and poor affectionate support (AOR=l.82; CI=1.03 - 3.22). Feeling depressed (p =0.001), unacceptable clinic waiting time (p =0.022) and dissatisfaction with support received from partner (p<0.001) were independent risk factors associated with non-adherence. Poor social support is a risk factor for non-adherence. Satisfaction with support received from one's partner is protective of non-adherence. Emphasis should be placed on the importance of social support during adherence counseling sessions on every ARV clinic visit. Couple-based counseling should be incorporated into the adherence counseling sessions for HIV patients to improve the support received from partner and promote adherence to ART.