HIV-related stigma and psychological distress in a cohort of patients receiving antiretroviral therapy in Nigeria.

Psychological distress is increasingly recognized as a barrier to engagement in HIV care, resulting in poor HIV outcomes. HIV-related stigma is a potential driver of distress in people living with HIV (PLWH). We conducted a prospective cohort study in 288 PLWH who newly initiated ART in a Nigeria. We assessed overall stigma (range 40-160) and four stigma subtypes (personalized, disclosure, negative self-image, and public stigma) at enrollment, and assessed psychological distress at enrollment, 6, and 12-months after ART initiation. We used logistic regression to assess the relationship between stigma and 12-month psychological distress. Overall stigma was high (102.34 ± 5.65) and was higher in both unmarried patients (p < 0.01) and those who had not disclosed their HIV status to anyone at enrollment (p < 0.01). Higher overall stigma (OR: 1.05, 95% CI 1.00-1.09) and personalized stigma (OR:1.08, 95% CI 1.00-1.16) were associated with higher odds of psychological distress at 12-months. Conclusions: Overall stigma levels were high in a cohort of PLWH initiating care in Nigeria. Higher stigma was associated with psychological distress. These data support the need for integration of measures to reduce stigma and psychological distress in the care of PLWH.

Knowledge of Hypertension and Compliance with Therapy Among Hypertensive Patients in the Bamenda Health District of Cameroon: A Cross-sectional Study.

INTRODUCTION: The prevalence of hypertension has continued to increase and is now a great burden for health care providers. Obtaining information on the factors affecting compliance to antihypertensive drugs is thus important. The aim of this study was to assess knowledge of hypertension and to determine factors affecting the compliance of hypertensive patients to their antihypertensive drugs. METHODS: This was a cross-sectional study involving 221 hypertensive patients in the Bamenda Health District. Validated questionnaires were used. From December 2014 to March 2015, knowledge of hypertension was assessed using a 15-item scale, while compliance was assessed using the 8-item Morisky Medication Adherence Scale. Statistical analysis was performed using SPSS version 20. RESULTS: 14.0%, 53.4%, and 32.6% of participants had adequate, average, and poor knowledge of hypertension, respectively. The antihypertensive compliance rate was 43.9%. Independent predictors of noncompliance were forgetfulness (OR = 0.011, 95% CI = 0.002-0.063), lack of motivation due to the incurable nature of the disease (OR = 0.068, 95% CI = 0.017-0.274), and lack of symptoms of the disease (OR = 0.019, 95% CI = 0.02-0.23). There was a significant association between compliance and blood pressure control (p < 0.001). CONCLUSION: Knowledge of hypertension was poor. Compliance rate to treatment was low. Some medication-related, patient attitude, and health care provider factors affected compliance. Knowledge positively affected compliance, and good compliance was associated with good blood pressure control. Emphasis should be placed on patient education and reminders to patients to take their drugs.