title: Adherence to Anti-Retroviral Therapy in North Central Nigeria.
abstract: BACKGROUND
  Nigeria bears nearly 10% of the global burden of HIV/AIDS. Most of the AIDS patients dwell in the part of Nigeria known as the "North Central" geopolitical region. Sustaining HIV patients in this high risk region is critical for the overall success of the ART program in Nigeria. We assessed the level of adherence to ART and adherence determinants among participants who had been on ART for an average of three and half years.
  
  
  METHODS
  Eligible study participants initiated HAART between 2004 and 2010. HAART regimens contained AZT/3TC +NVP or EFV; AZT/3TC/NVP; 3TC/NVP/d4T; TDF/FTC +EFV or NVP and TDF+3TC+LPV/r. A composite adherence measure defined as not missing a dose and taking the correct dose and adhering to the correct frequency and correct schedule of drug administration was used to assess self-reported adherence over a period of three days. Selfreported adherence was validated with viral load test. Base line adherence was fixed at ≥95% adherence level. Significant test was fixed at p<0.05.
  
  
  RESULTS
  We included 502 participants in the analysis. Median age for men was 42 years (IQR: 38 - 44 years) and women, 36 years (IQR: 30-40 years). Mean duration of therapy was 43 (16-70) months. Effective self-reported adherence was 97.3%. Only age and virologic suppression were significantly associated with adherence to ART. Forgetfullness (43%) was the major reason for non-adherence, while improvement in health condition (40%) was the main facilitator of adherence to the medications.
  
  
  CONCLUSIONS
  Most participants achieved optimal adherence (≥95%) with high virologic suppression. Strategies to sustain optimal adherence, e.g., the use of fixed dose combinations (FDCs) and comprehensive adherence counselling should be maintained.
authors: Institute of Human Virology, Pent House, Maina Court, Plot 252, Herbert Macaulay Way, Central Business District, Federal Capital Terrirtory, Abuja, Nigeria. yavong@ihvnigeria.or.
authors: Yohanna Kambai
authors: YK
authors: Avong
authors: Brian
authors: B
authors: van Wyk
authors: Jean
authors: J
authors: Njab
authors: Alash'le G
authors: AG
authors: Abimiku
authors: Nicaise
authors: N
authors: Ndembi
authors: James
authors: J
authors: Okuma
authors: Obinna
authors: O
authors: Ogbanufe
authors: Ernest
authors: E
authors: Ekong
authors: Patrick
authors: P
authors: Dakum
authors: William A
authors: WA
authors: Blattner
mesh_terms: D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology; D008875:Middle Aged; D009549:Nigeria; D012307:Risk Factors; D019562:Viral Load; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents