Predictors of Adherence to Highly Active Antiretroviral Therapy among People Living with HIV/AIDS in Akwa Ibom State, Nigeria

Abstract

Adherence to Highly Active Antiretroviral Therapy (HAART) remains critical for achieving viral suppression and reducing HIV-related morbidity and mortality, particularly in high-burden settings such as Akwa Ibom State, Nigeria. This study assessed the level of HAART adherence and its associated predictors among People Living with HIV (PLHIV) receiving antiretroviral therapy in Akwa Ibom State.
A descriptive cross-sectional study design was employed among 200 PLHIV accessing HIV care services in selected ART-supported health facilities across Akwa Ibom State. Data were collected using a structured, interviewer-administered questionnaire. HAART adherence was assessed using a four-day recall method. Descriptive statistics were used to summarize respondents’ characteristics, while chi-square tests were conducted to determine associations between HAART adherence and selected patient-related, socio-cultural, and health-system factors at a significance level of p < 0.05.
The study found that 79.5% of respondents were adherent to HAART, a level below the World Health Organization recommended threshold of ≥95%. HIV status disclosure (χ² = 9.21; p = 0.002), family support (χ² = 6.74; p = 0.009), and use of medication reminders (χ² = 18.63; p < 0.001) were significantly associated with better adherence. Conversely, fear of stigma (χ² = 11.84; p = 0.001) and long clinic waiting times (χ² = 13.02; p < 0.001) were significantly associated with non-adherence. Forgetfulness, treatment fatigue, and health-system barriers were identified as major challenges to optimal adherence.
In conclusion, HAART adherence among PLHIV in Akwa Ibom State is moderately high but remains suboptimal. Adherence is influenced by an interplay of patient-related, socio-cultural, and health-system factors. Strengthening adherence counselling, promoting safe disclosure, integrating family and digital reminder support, reducing clinic waiting times, and intensifying anti-stigma interventions are essential for improving treatment outcomes and achieving sustained viral suppression in Akwa Ibom State.