Medication Adherence and Risk Factors for Non-adherence among Patients taking Highly Active Antiretroviral Therapy

Background: ART is a life long treatment and its effectiveness depends critically both on the efficacy of the antiretroviral drugs against the virus, and achieving a very high level of adherence (> 95 %) to the medications. Adherence poses a special challenge and requires commitment from the patient and the health care provider.Objectives: The study evaluated medication adherence, and identified risk factors for non-adherence in HIV-infected ART patients.Methods: In a cross-sectional survey, medication adherence of 118 HIV-infected ART patients who received pretreatment and ongoing adherence counseling and education for 6 months was evaluated using a self-administered studyspecific 16-item questionnaire. Self-reported adherence was calculated as the mean of patients' adherence to the medication schedule and the number of prescribed doses of medications missed. Chi-square statistics was used to test the association of adherence with occupation and education at 95 % CI.Results: The mean age of participants was 33.9 (95 % CI, 29.6-38.2) years; and 82.2 % of participants were aged 26-45years; 60.2 % females, 80.5 % attained secondary education at the least; and 77.1 % were employed. All participants reported been counseled on the benefits of ART and medication adherence at ART initiation. On assessment of participants' knowledge of the benefits of ART and medication adherence, 92.2 % were very knowledgeable, 2.9 %reported wrongly that ART is a cure for HIV. The self-reported adherence to medication schedule was 68.9 %(range: 0 % - 100 %), of which 83 (70.3 %) reported > 75 % adherence; while adherence to prescribed doses of medications was 89.2 % (range: 20 % - 100 %), of which 100 (84.7 %) participants reported > 80 % adherence. Mean self-reported adherence (±SD) was 79.1 % ± 14.4 %. Employment status was associated with poor adherence (P < 0.05), unlike the educational status. The major reasons reported for non-adherence were busy at work or school (33.1 %), forgetfulness (15.5 %), fasting (12.0 %), and travelled away from home (10.6%). Conclusion: The self-reported adherence was relatively poor compared to the desired value of > 95%. Employment status was associated with poor adherence and this may be corroborated by the major reason reported for non-adherence (busy at work or school). Routine adherence monitoring and multiple adherence interventions in clinical practice are recommended

Health-Related Quality of Life and CD4 Cells Status of Patients Receiving Antiretroviral Therapy in Nigeria

Background: The goals of antiretroviral therapy (ART) are to improve patient's health-related quality of life (HRQOL) and restore immunologic function among others. Objectives: The study evaluated HRQOL and CD4-cells response of HIV-infected patients at months 0 and 6 of receiving ART in Maitama District Hospital Abuja, Nigeria. Methods: HRQOL of a cohort of 150 HIV-infected patients was evaluated at months 0 and 6 of receiving ART using Medical Outcomes Study Short Form-36 (MOS SF-36) which has 8 domains. These include physical functioning, physically and emotionally related role limitations, social functioning, pain, energy/fatigue, emotional well-being and general health. A paired samples t-test was used to compare the HRQOL scores and CD4 cells count of participants at months 0 and 6. Wilcoxon's signed-ranks test was used to compare HRQOL of male and female participants. At two-tailed test, p value of <0.05 was considered significant. Results: The mean age (±SD) of the 150 participants at ART initiation was 34.3 ± 8.4 years; 59.3% were females. The mean (±SD) HRQOL of participants increased significantly from 71.9% ± 20.9 at ART initiation to 89.7% ± 10.6 after 6 months of ART (p<0.05). The change in all SF-36 domains was statistically significant (p<0.05) except for the domains of role limitation due to emotional problems, social functioning and pain. The improvement in the mental component score (MCS) was significant (p<0.05) unlike that of the physical component (PCS). The difference in the HRQOL of male and female participants at months 0 and 6 was not significant. The mean CD4 cell count (±SD) increased from 185.7 ±91.0 cells/mm3 at month 0 to 199.0 ±104.7 cells/mm3 after 6months of ART; though this increase was not statistically significant. Conclusion: There was significant improvement in the mean HRQOL scores of participants which was not associated with significant improvement in the CD4 cells status after six months of ART. The evaluation of HRQOL alongside the clinical and immunological parameters when monitoring treatment outcomes is recommended

Knowledge Attitude and Practice about Breast Cancer among Civil Servants in Benin City; Nigeria

Background: Breast cancer is often associated with severe morbidity and mortality especially when the patients present late. A major reason why patients present late is the lack of awareness about breast cancer; its complications and the management. Methods: The study was carried out using a structured questionnaire. A total of 400 female civil servants were enlisted in the study; but only 385 respondents completed and returned the forms. Results: Two hundred and seventy seven (72.0) respondents had tertiary level of education. Sixty six (17.1) respondents were in the 30-34-year age group. Three hundred and twelve (81.0) respondents knew correctly that breast lump is usually the first symptom of presentation of breast cancer. One hundred and forty four (37.5) respondents knew that a positive family history of breast cancer is a risk factor; while two hundred and seventy four (71.2) respondents answered that cancer of one breast in a woman increases her chances of having cancer of the other breast. Three hundred and twenty one (83.4) respondents knew that breast cancer could spread from one breast to the other and two hundred and thirty (59.7) knew that breast cancer could spread to other parts of the body. One hundred and eighty three (47.5) respondents would visit the hospital as the first reaction if they were to detect a breast lump; while twenty three (6.0) respondents would ignore the lump. While three hundred and twenty seven (85.0) respondents have heard of breast self- examination; only one hundred (26.0) could correctly describe the procedure of breast self -examination. While one hundred and thirty five (35.0) respondents have heard of mammography; only twenty seven (7) respondents go for yearly mammography screening. Three hundred and seventy two (96.6) respondents know that mastectomy is done as part of the management of breast cancer; but only forty nine (12.7) respondents have heard about conservative surgery. Conclusion: The level of awareness about breast cancer among civil servants in Benin City is low. There is the need to organize series of health education programs to enlighten the women about breast cancer. This can be done by government agencies or the non-governmental organizations. If properly executed; it may influence the attitude of women in Benin City about breast diseases and encourage early presentation to the hospital

Attitude and practice of health care workers in a tertiary health facility towards voluntary counselling and testing for HIV

Context: Nigeria is right now battling with the epidemic of HIV/AIDS with a median prevalence of 5.0. Voluntary counselling and testing (VCT) is being advocated so that people can know their HIV status and modify their behaviour appropriately. Health workers are at risk of contracting and spreading the HIV infection and it would therefore be needful for them to know their status and they also are in a vantage position to promote and encourage VCT. This study was therefore designed to assess their attitude and practice towards this strategy. Methodology: A cross-sectional descriptive study was conducted among health workers in the University of Benin Teaching Hospital; a tertiary health institution in Benin City; Edo State between October 2002 and April 2003 using a stratified random sampling method in selecting respondents. Information was obtained through the use of self-administered questionnaire. Results: A total of 242 health workers made up of 48.8 doctors; 33.1 nurses; 11.2 laboratory scientists and 6.9 pharmacists were involved in the study. Mean age of respondents was 35.8 + 8.7 years. One hundred and seventy four (71.9) had actually been screened for HIV. Eighty-two (47.1) of these did so voluntarily while it was mandatory for 92 (52.9) others. A total of 227 (93.8) appreciated the importance of knowing one's HIV status observing that it will enable them take precautions (52.1) and enable them commence treatment early; (19.4). Conclusion: Since VCT for HIV is an important component of HIV prevention and care; it should be promoted in health care settings