




































_____________________________________________________________________________________________________ 
 
*Corresponding author: E-mail: adediranmoras@gmail.com; 
 
 
 

Asian Journal of Immunology 
 
2(1): 45-55, 2019; Article no.AJI.53020 
 

 
 

 

 

Studies on the Adherence to Antiretroviral Therapy 
(ART) among HIV Patients Receiving Treatment in a 

Major HIV Care Unit in Akure, Ondo State, Nigeria 
 

T. A. Olusi1, M. B. Adediran1* and M. O. Oniya1  
 

1
Federal University of Technology, Akure, Nigeria. 

 
Authors’ contributions  

 
This work was carried out in collaboration among all authors. Author TAO designed the study, wrote 

the protocol and managed the literature searches. Author MBA performed the statistical analysis and 
wrote the first draft of the manuscript. Author MOO managed the analyses of the study. All authors 

read and approved the final manuscript. 
 

Article Information 
 

Editor(s): 
(1) Dr. Darko Nozic, Professor, Higher Medical School in Belgrade, University of Belgrade, Serbia. 

Reviewers: 
(1) Rajathi Sakthivel, Dr. M.G.R  Medical University, India. 

(2) Alma M. Corpuz, Tarlac State University, Philippines. 
Complete Peer review History: http://www.sdiarticle4.com/review-history/53020 

 
 
 
 

Received 01 October 2019  
Accepted 04 December 2019 
Published 11 December 2019 

 
 

ABSTRACT 
 

There has been great improvement in the life expectancy for HIV patients since the introduction of 
Antiretroviral Therapy (ART). However, good adherence to regimen is important to surmounting 
health problems associated with HIV/AIDS. While availability of drugs and accessibility to it are 
important, many other social, psychological and clinical factors needed to be considered. This 
cross- sectional study seeks to determine adherence to ART among 441 patients living with HIV 
and attending the State Specialist Hospital, Akure for treatment. The participants included more 
females (79.1%) while the remaining 20.9% were males. Majority of the participants were married 
(71.2%) and 73.0% of them earn less than ₦18000 (about US$52) monthly. Only 29.7% of them 
enrolled for ART less than six (6) months to the commencement of the study. Adherence in this 
study was found to be 56% and was significantly related to age (χ

2 
= 14.31, P = 0.03), marital 

status (χ
2 

= 9.47, P = 0.01), medication burden (χ
2 

= 9.07, P = 0.01) and “ART type” (χ
2 

= 19.09,                
P = 0.00). The adherence rate (56%) recorded in the study is however low and underscores the 
need for measures necessary in ensuring total adherence among people living with HIV in Ondo 
State Nigeria.  

Original Research Article 



 
 
 
 

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46 

 

Keywords: Adherence; antiretroviral therapy; HIV; Ondo State; Nigeria.   
 

1. INTRODUCTION 
 
The continuous increase in new HIV infections 
despite improved antiretroviral therapy (ART) 
regimen calls for concern, especially in Sub-
Saharan Africa, which bears the highest burden 
of the infection and particularly in Nigeria, where 
the lowest record of reduction in new HIV 
infections was obtained since 2009 according to 
UNAIDS 2016 report. Issues bordering on factors 
including adherence, retention in care and issues 
on drug resistance were topics of hot debate few 
years ago while introducing ART to Sub-Saharan 
Africa [1]. The eventual advent of very highly 
active antiretroviral treatment has reduced 
morbidity and mortality, improved life expentancy 
among HIV infected persons, enhanced 
immunity, sustained viral load suppression and 
reduced the risk of transmission in countries 
where they have been made available and 
accessible. However, adherence to medication 
and retention in care are still factors needed to 
be addressed in order to achieve optimum 
benefits because instances of drug-resistant HIV 
strains and the continuous transmission of these 
strains in the population have long been 
attributed to sub-optimal adherence among HIV 
infected people [2]. 
 
Adherence is the rate at which an individual’s 
behaviour, compliance to medication, sticking to 
a diet, changing lifestyle and compliance to 
schedule visits and clinicians assessment 
conforms to standard recommendations of health 
officials [3]. According to Moges and Kassa [4], 
adherence is classified as good if is greater than 
95% and poor if it is less than 85%. Poor 
compliance to medication not only put an 
individual’s health at risk but may also lead to 
increase in viral transmission and drug 
resistance which subsequently make treatment 
difficult [5]. The recommended percentage of 
adherence to maintain long term viral 
suppression is 95% and several studies 
conducted on HIV infected persons (children, 
adolescents and adults) were reported to fall 
below 95% [6,7,8,9,10,11,12].  
 
Several factors may be responsible for non-
adherence among HIV infected persons. For 
example in Nigeria, a structurally induced non-
adherence was said to be created in the year 
2004, when the national ARV programme 
organized by the federal government of Nigeria 
suffered a setback, after being affected by a 

shortage in the supply of drugs. This caused 
many patients to be out of drugs for few months 
[13]. There had been cases where only 15% of 
people in need of ARV in Nigeria had access to 
treatment [11]. All of these further lay credence 
to the fact that availability and accessibility of 
drugs are important in ensuring compliance. Cost 
of medication, adverse side effects, alcohol 
abuse and social stigma are among other factors 
reportedly to have been responsible for non-
adherence. Castro [14] has however viewed 
barriers to adherence as dynamic interactions of 
biologic and social factors. 
 
In Nigeria, reports of previous studies shows 
adherence to have ranged from as low as 44% to 
more than 95% [15,16]. Several studies on 
adherence have been reported in cities such as 
Ibadan, Enugu, Port-Harcourt, Benin, Ijesha, keffi 
and kano [17]. Reports on adherence of patients 
receiving ART in Ondo state are still limited and 
therefore necessitate enquiries to generate data 
for effective decision making on intervention 
measures that gives better hope for positive 
improvements. This study was therefore, 
designed to investigate adherence of HIV 
infected individuals to ART in Akure the capital 
city of Ondo-State and factors influencing non-
adherence. 
 

2. MATERIALS AND METHODS  
 
2.1 Study Site 
 
The study was conducted at the HIV care unit of 
the Ondo State Specialist Hospital in Akure 
These facilities attend to patients living in Akure 
and indeed most towns in the state on a daily 
basis but operate full clinic activities on Tuesdays 
and Thursdays. 
 

2.2 Study Population 
 

The study population includes 441 individuals 
living with HIV who are on ART whose ages 
ranged between six (6) and sixty-five (65) years. 
Criteria for inclusion includes  HIV positive 
status, ART not less than three months to the 
time of study, willingness to participate and 
availability of parents of patients less than 18 
years of age (most of these parents were found 
also to be living with HIV). Appropriate sample 
size was calculated based on the number of 
patients enrolled in the facility. During the study 
period of four months, a total of 1,286 patients 



 
 
 
 

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47 

 

visited the HIV clinics out of which 441 were 
recruited to take part in the study. The sample 
size was calculated based on the estimated 
population proportion of 50 percent, a confidence 
level of 90 percent and alpha value of 0.05 using 
z

2 
1-α/2P (1 – P)/d [18]. 

 

2.3 Study Design 
 
The study design was a facility based cross 
sectional study. Consenting patients and parent 
of patients less than 15 years old were 
interviewed by the researcher using a pretested 
and structured questionnaire adapted from 
AACTG (Adults Clinical Trials Group) that 
covered socio demographic information, 
psychosocial characteristics, ART duration, 
medication burden, type of ART (whether free 
treatment, paid treatment or both).  
 

2.4 Adherence Measurement 
 
The golden standard for assessing adherence is 
the ARV level in the blood. Viral load could also 
be used as a measure for adherence but data 
emanating from self-reports are easily accessible 
(Afe et al., 2018) and according to Dolezal et al. 
[9] self reported data correlates with viral loads. 
Therefore, for this study, adherence was rated 
through the self reported data obtained from the 
participants using a 4-day recall semi structured 
follow up questionnaire adapted from Adults 
AIDS Clinical Trials Group (AACTG) [19]. The 
percentage of adherence was obtained by 
dividing the total number of drugs taken in the 
last four days by the total number of drugs 
recommended to be taken for the four days 
multiplied by 100 as summarized below. 
Adherence was then categorized as greater or 
equal to 95% and non-adherence as less than 
95%.  
 

((Total number of drugs taken / Total number 
of drugs prescribed) x (100/1)) 

 

2.5 Statistical Analysis  
 
Data collected were entered into Excel 2007 
worksheet and imported into SPSS version 23.0 
for Windows. The Chi-square test was used to 
measure adherence in relation to socio 
demographic variables, while the logistic 
regression was used to find association between 
risk factors that could have influenced non-
adherence in HIV infected people. The strength 
of associations were measured using adjusted 

odd ratios (95% confidence interval).   values 
less than 0.05 were considered statistically 
significant. 
 

3. RESULTS 
 
3.1 Socio-economic and Demographic 

Characteristics of Participants 
 
The 441 subjects recruited for this study 
comprises of 92(20.9%) males and 349(79.1%) 
females, an indication that the majority of them 
were females and all the subjects had formal 
education though not to tertiary level as majority 
235(53.3%) had secondary education, while only 
40(9.1%) had tertiary education and the 
remaining had primary education 166(37.6%). 
Most of the participants 225 (50.5%) were 
engaged in business as means of income while a 
good number of them 103(23.4%) were not 
employed. A larger percentage of them were 
married 314(71.2%) with 72 (16.3%) of them 
separated from their spouses while 55 (12.5%) of 
them had never married. A larger percentage of 
the participants had less than ₦18,000 has their 
average monthly income 322(73.0%). 
 

3.2 ART Type of Participants 
 
Majority of the participant 269 (61.0%) were on 
free medication while 63 (14.3%) preferred 
buying their medications and 24.7% of them 
engaged in both options i.e they were also on 
free medications but purchase when their 
antiretrovirals clinics were out of stock). Almost 
all the participants of aged 61 and above (91.7%) 
received free medications. A larger percentage of 
the female participants 236 (67.6%) were on free 
medication. Most patients that depended on free 
medication 113(68.1%) had only primary 
education while many participants who buys their 
medication (45.0%) were educated up to the 
tertiary education level. Most of those who 
prefers free ART (65.6%) were business men 
and women and they are married (64.6%) 
earning less than ₦18000 monthly income 
(68.3%). 
 

3.3 HIV Patients Adherence to ART  
 

As shown in Table 3, the highest percentage of 
adherence was recorded among the female 
participants 210 (60.2%) while 51.1% of males 
adhered. Adults aged between 41-50 adhered 
most while participant between ages 21-30 had 
the highest percentage for non-adherence 



 
 
 
 

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48 

 

33(56.9%). Participants who are educated up till 
tertiary level and those unemployed had the 
highest percentage of adherence 27(67.5%) and 
58(63.7%) respectively. Most of the married 
participants (62.7%) adhered to medication while 
participant who no longer live with their spouses 
had the least adherence (55.6%). Participants 
who benefitted from free medication when 
accessible and pay for it when out of stock had 
the highest level of adherence (76.1%) while 
those who only prefers buying their medication at 
all times had the lowest adherence (49.2%). 
 

3.4 Adherence to ART in Relation to 
Socio-demographic Factors 

 

Table 4 summarizes adherence among 
attendees of HIV care unit in Akure, Ondo state, 
based on their socio-demographic parameters. 
Adherence was higher among female patients. 
Adherence was higher among female patients 
60.2% (210/349) with no significant difference in 
adherence on the basis of sex (χ

2
= 2.47, 

P=0.12). There is however a significant variation 

in the adherence of patients in relation to their 
ages (χ

2
= 14.31, P=0.03). Adherence in relation 

to their level of education varies from 54.0% to 
67.5% (χ

2
= 4.10, P=0.13). With regard to marital 

status and occupation of the patients, adherence 
varied between 44.4% and 62.7% (χ

2
= 9.47, 

P=0.01) and 38.8% and 63.7% (χ
2
= 9.55, 

P=0.05) respectively. Married patients 
significantly adhered (62.7%, 197/314) compared 
to others, also patients who are not employed 
adhered significantly with 63.7% (58/91). 
 

3.5 Participant’s Adherence in Relation to 
Psycho-socio Factors 

 
Patients with family support adhered significantly 
(66.8%) compared to those without family 
support (Table 5). Participant who reported no 
adverse effect of medication adhered more 
(61.1%) to treatment compared to 52.4% level 
recorded among patients who reported adverse 
effect of medication although the variation is 
statistically not significant (χ

2 
=3.05, P = 0.08). 

Adherence in relation to the overall clinic 
  

Table 1. Socio-economic and demographic characteristics of participants 
 

Factors  Total examined (%)  

Age group  

0-10 39(8.8)  
11-20 23(5.2)  
21-30 58(13.2)  
31-40 156(35.4)  
41-50 116 (26.3) 
51-60 37(8.4)  
61 and above 12(2.7)  

Sex   

Male 92(20.9)  
Female 349(79.1)  

Educational level  

Primary 166 (37.6) 
Secondary  235(53.3) 
Tertiary  40(9.1) 

Employment   

Student 61 (13.8) 
Civil servant 37(8.4) 
Business 223(50.5) 
Farming  17(3.9) 
Not employed 103(23.4) 

Marital status  

Married  314(71.2)  
Separated  72(16.3) 
Never married 55(12.5)  

Average monthly income   

<18000 322(73.0)  
18,000-40,000 73(16.6) 
>40,000 46(10.4)  



 
 
 
 

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49 

 

Table 2. Distribution of patients living with HIV undergoing treatment based on their ART type 
 

Factors  Paid ART 
treatment (%) 

Free ART 
treatment (%) 

Free and paid 
treatment (%) 

Total examined 
(%)  

Age group 63(14.3) 269(61.0) 109(24.7) 441(100) 

0-10 6(15.4) 28 (71.8) 5 (12.8) 39(8.8)  
11-20 4 (17.4) 16 (69.6) 3 (13.0) 23(5.2)  
21-30 12 (20.7) 29 (50.0) 17 (29.3) 58(13.2)  
31-40 21 (13.5) 87 (55.8) 48 (30.8) 156(35.4)  
41-50 11 (9.5) 76 (65.5) 29 (25.0) 116 (26.3) 
51-60 8 (21.6) 22 (59.5) 7 (18.9) 37(8.4)  
61 and above 1 (8.3) 11 (91.7) 0 (0.0) 12(2.7)  

Sex      

Male 24 (26.1) 33(35.9) 35 (38.0) 92(20.9)  
Female 39 (11.2) 236 (67.6) 74 (21.2) 349(79.1)  

Educational 
level 

    

Primary 13 (7.8) 113 (68.1) 40 (24.1) 166 (37.6) 
Secondary  38 (16.2) 138 (58.7) 59 (25.1) 235(53.3) 
Tertiary  12 (30.0) 18 (45.0) 10 (25.0) 40(9.1) 

Employment      

Student 11 (18.0) 34 (55.7) 16  61 (13.8) 
Civil servant 12 (32.4) 16 (43.2) 9 (24.3) 37(8.4) 
Business 28 (12.6) 146 (65.6) 49 (22.0) 223(50.5) 
Farming  3 (17.6) 7 (41.2) 7 (41.2) 17(3.9) 
Not employed 9 (8.7) 66 (64.1) 28 (27.2) 103(23.4) 

Marital status     

Married  39 (12.4) 203 (64.6) 72 (22.9) 314(71.2)  
Separated  16 (22.2) 34 (47.2) 22 (30.6) 72(16.3) 
Never married 8 (14.5) 32 (58.2) 15 (27.3) 55(12.5)  

Economic tatus     

<18000 24 (7.5) 220 (68.3) 78 (24.2) 322(73.0)  
18,000-40,000 21 (28.8) 33 (45.2) 19 (26.0) 73(16.6) 
>40,000 18 (39.1) 16 (34.8) 12 (26.1) 46(10.4)  

Time since 
starting ART 

    

<6 20 (15.3) 96 (73.3) 15 (11.5) 131(29.7)  
12-24 24 (15.4) 94 (60.3) 38 (24.4) 156(35.4)  
>24 19 (12.3) 79 (51.3) 56 (36.4) 154(34.9) 

 
satisfaction of the patients varied from Excellent 
or very good (59.9%) to fair or poor (57.0%) with 
no significant difference (χ

2
 =0.39, P=0.54). With 

regards to alcohol consumption, adherence rate 
of 59.6% was recorded among tattlers while 
36.0% of those who reportedly take little 
quantities of alcohol adhered to ART medication. 

 
3.6 Participant’s Adherence in Relation to 

Medication 
 
Patients taking just a single pill of medication 
adhered significantly (χ

2
=9.07,P= 0.01) 

compared to those burdened with between 2-
3(60.9%) or more pills(44.3%). There is                   
also a significant difference (χ

2
=19.09, P= 0.00) 

among patients preference of access                    
to ART. The highest percentage of adherence 
(76.1%) was obtained among those who 
sometimes pay for treatment whenever free 
supply is not accessible. With regard to 
knowledge of medication and number of 
hospitalizations due to HIV related illnesses, 
adherence varied between 58.1% and 58.9% 

(χ
2
=0.02;  = 0.88) and between 67.0% and 

55.9% (χ
2
= 3.76;   = 0.15), respectively. 

 
4. DISCUSSION 
 
Adherence to medication regime is very 
important in the management of HIV infection 
because it helps to sustain viral suppression,



 
 
 
 

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50 

 

Table 3. Compliance to ART among the various socioeconomic group of attendees (N=441) 
 

Factors  Adherence (%) Non-adherence(%) Total examined (%) 

Sex     

Male 47 (51.1) 45 (48.9) 92(20.9) 
Female 210 (60.2) 139 (39.8) 349(79.1)  

Age group    

0-10 21 (53.8) 18 (46.2) 39(8.8)  
11-20 12 (52.2) 11 (47.8) 23(5.2)  
21-30 25 (43.1) 33 (56.9) 58(13.2)  
31-40 92 (59.0) 64 (41.0) 156(35.4)  
41-50 81(69.8) 35 (30.2) 116(26.3)  
51-60 18 (48.6) 19 (51.4) 37(8.4) 
61 and above 8 (66.7) 4 (33.3) 12(2.7) 

Educational level    

Primary 103 (62.0) 63 (38.0) 166(37.6)  
 Secondary  127 (54.0) 108 (46.0) 235(53.3)  
Tertiary  27 (67.5) 13 (32.5) 40(9.1)  

Employment     

Student 38 (62.3) 23 (37.7) 61(13.8)  
Civil servant 19 (38.8) 30 (61.2) 49(11.1)  
Business 133 (59.6) 90 (40.4) 223(50.6)  
Farming  9 (52.9) 8 (47.1) 17(3.9)  
Not employed 58 (63.7) 33 (36.3) 91(20.6) 

Marital status    

Married  197 (62.7) 117 (37.3) 314(71.2)  
Separated  32 (44.4) 40 (55.6) 72(16.3)  
Never married 28 (50.9) 27 (49.1) 55(12.5)  

Type of ART    

Free ART 142 (52.8) 127 (47.2) 269(61.0)  
Pay out of pocket 32 (50.8) 31 (49.2) 63(14.3) 
Both  83 (76.1) 26 (23.9) 109(24.7)  

Family support     

Yes  231 (66.8) 115 (33.2) 346(78.5)  
No  26 (27.4) 69 (72.6) 95(21.5)  

 
recover immunity, reduce morbidity due to 
infection and hinder the development of drug 
resistance strain of the virus [20]. The present 
study shows 56% (χ

2
=2.47, P=0.12) adherence 

among participants studied at the HIV care unit in 
the Ondo state specialist Hospital Akure.             
Some other studies across the country have 
reported a higher proportion of adherence 
between 70% to 86% [17,21,22,23], (Uzochukwu 
et al., 2009). A recent study done in the 
southwestern states of Nigeria reported 42% 
adherence among study participants [24]. Some 
other studies have equally reported adherence of 
between 44%-65% [25, 26], (Uzochukwu et al., 
2009). 
 

Adherence was found in this study to be 
significantly related to age (χ

2
= 14.31, P=0.03) 

where adults aged 41-50 years recorded the 
highest rate of adherence of 69.8%.This agrees  
with the findings of  Suleiman and Momo [17] 

where adherence in participants studied in 
Bayelsa state were found to be age related. Most 
of the parents and guidance of children less than 
15 years opined that forgetfulness is a major 
barrier to adherence on their part. This was also 
applicable to participants of between ages 20 
and 40 where preoccupation with other domestic 
chores and fear of side effects were the major 
hindrance to optimum adherence. Adherence on 
the basis of marital status of  participants was 
also found to be statistically significant (χ

2
= 9.47, 

P=0.01), where participants who are married 
adhered to ART more than others who were 
either single or separated from their spouses. 
This is different to the findings of Afe et al., [24] 
where no relationship exist between marital 
status and adherence. 
 

Family support have been identified as an 
important factor that determines adherence to 
ART. This study observed that patient with good 



 
 
 
 

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51 

 

family support adhered more in comparism with 
their counterparts who do not have support. 
Interactions with the patients in the course of the 
study revealed that many participants without 
support are persons who conceal their status 
from their families. It was also observed that 
patients who were no longer living with their 
spouses admitted that their health status was the 
actual cause of separation and if given another 
chance, they would not disclose to their spouses. 
Some other patients mostly from polygamous 
families had vowed never to disclose their status 
to anyone since they did not even know how they 
got infected with HIV. Adherence based on 
medication burden was also found to be 
statistically significant as the rate of adherence 
decreased with increase in the number of pills. 
This is in support of the opinions of Ogba [27], 
Lucas and Gilles [28] that increase in the 
complexity of regimen for many chronic diseases 

including HIV/AIDS often leads to decrease in 
adherence. 
 
Based on “ART type,” participants for the study 
were grouped into three. These include (i) those 
that solely depended on free anti-retroviral drugs 
(ii) those that prefer buying their medication (pay 
out of pocket) and (iii) those who get free drugs 
but buys when clinics were out of stock. 
Adherence among the three groups was found to 
be statistically significant (χ

2
= 19.09, P=0.00) as 

76.1% of the third category adhered to their 
medication. This group of patient can however be 
said to be self- motivated to take ART. This 
support the findings of Achappa et al., [29] where 
patients, who were self-motivated recorded high 
level of adherence. In a study by Sarna et al., 
[18], adherence was found to be low among 
patients receiving free ART. According to 
Ayenigbara [30], non-availability of ARV drugs is

 
Table 4. Univariate and multivariate analysis of participants’ adherence in relation to socio 

demographic factors (N=441) 

 
Factors  Adherence (%) Total examined  χ

2
 P AOR (95% CI) P 

Sex    2.47 0.12 0.69(0.44-1.09) 0.12 

Male 47 (51.1) 92     
Female 210 (60.2) 349      

Age group   14.31 0.03 0.88(0.77-1.01) 0.07 

0-10 21 (53.8) 39      
11-20 12 (52.2) 23      
21-30 25 (43.1) 58      
31-40 92 (59.0) 156      
41-50 81(69.8) 116      
51-60 18 (48.6) 37      
61 and 
above 

8 (66.7) 12      

Educational 
level 

  4.10 0.13 1.06(0.79-1.44) 0.69 

Primary 103 (62.0) 166      
Secondary  127 (54.0) 235      
Tertiary  27 (67.5) 40      

Marital 
status 

  9.47 0.01 1.40(1.07-1.84) 0.01 

Married  197 (62.7) 314      
Separated  32 (44.4) 72      
Never 
married 

28 (50.9) 55      

Employment    9.55 0.05 0.92(0.79-1.07) 0.29 

Student 38 (62.3) 61      
Civil servant 19 (38.8) 49      
Business 133 (59.6) 223      
Farming  9 (52.9) 17      
Not 
employed 

58 (63.7) 91      

Key: AOR = adjusted odd ratio 



 
 
 
 

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52 

 

Table 5. Univariate and multivariate analysis of participant’s adherence in relation to psycho-
socio factors 

 

Factors  Adherence 
(%) 

Non-adherence 
(%) 

Total 
examined  

χ
2
 P AOR (95% 

CI) 
P 

Family 
support  

   47.57 0.00 5.33 
(3.22-8.82) 

0.00 

Yes  231 (66.8) 115 (33.2) 346      
No  26 (27.4) 69 (72.6) 95      

Adverse 
effect 

   3.05 0.08 0.70 
(0.47-1.05) 

0.08 

Yes  76 (52.4) 69 (47.6) 145      
No  181 (61.1) 115 (38.9) 296      

Over all 
clinical 
satisfaction 

   0.39 0.54 1.13 
(0.77-1.65) 

0.54 

Excellent/very 
good 

118 (59.9) 79 (40.1) 197      

Fair/poor 139 (57.0) 105 (43.0) 244      

Alcohol    5.41 0.02 2.62 
(1.13-6.08) 

0.02 

No drinking 248 (59.6) 168 (40.4) 416      
Low drinking 9 (36.0) 16 (64.0) 25      

Key: AOR = adjusted odd ratio 
 

Table 6. Univariate and multivariate analysis of participant’s adherence in relation to 
medication 

 

Factors  Adherence 
(%) 

Total 
examined  

χ
2
 P AOR (95% CI) P 

Medication 
burden 

  9.07 0.01 1.49(1.11-2.01) 0.01 

One 62 (63.9) 97     
2-3  156(60.9) 256     
4 or more  39 (44.3) 88     

Knowledge of 
medications 

  0.02 0.88 0.97 (0.61-1.53) 0.88 

Knows 
medications 

201 (58.1) 346     

Does not know 56 (58.9) 95     

Type of ART   19.09 0.00 0.54 (0.39-0.79) 0.00 

Free ART 32 (50.8) 63     
Pay out of pocket 142 (52.8) 269     
Both  83 (76.1) 109     

No of 
hospitalization 
due to HIV 
related illness 

  3.76 0.15 0.77 (0.53-1.11) 0.17 

Never 185 (55.9) 331     
Once 63 (67.0) 94     
Twice or more 9 (56.3) 16     

Key: AOR = adjusted odd ratio 

 
a major cause of non-adherence especially for 
patients who completely rely on free supply of 
ARV drugs from government established HIV 

clinics. Paying for antiretroviral therapy may be a 
strong motivation for adherence but the financial 
implication may cause some setbacks. 



 
 
 
 

Olusi et al.; AJI, 2(1): 45-55, 2019; Article no.AJI.53020 
 

 

 
53 

 

The nature of participants employment was 
found to significantly (χ

2
= 9.55, P=0.05) influence 

their rate of adherence. Patients who were not 
employed were recorded the highest (63.7%), 
followed by those who engaged in business or 
are self-employed (59.6%). Civil servants had the 
least adherence rate of 38.8%. Majority of them 
cited forgetfulness as barrier to adherence as 
they would have gotten to their places of work 
before remembering that they had not taken the 
drugs. The suggestion of keeping the drugs in 
office bags and inside office was rejected by the 
patients because their children often search their 
bags and could find the drugs, others do not 
want people in their offices to know that they are 
living on drugs. Other reasons accounting for 
non-adherence in this study include pills stock 
out, busy schedules, religious fasting, and fear of 
experiencing side effects. 

 
Factors such as gender, knowledge of 
medication, number of hospitalizations due to 
HIV related illnesses, adverse effect, overall 
clinic satisfaction and educational status do not 
vary significantly among study participants. 

 
5. CONCLUSION 
 

The overall 56% adherence to ART among HIV 
infected people receiving care at the state 
specialist hospital Akure is very poor and calls for 
strategies to improve adherence to treatment and 
consistency in attendance of the patients bearing 
in mind that adherence is central to the overall 
wellness of these patients and therefore the 
above suggested recommendations may be 
employed.    

 
6. RECOMMENDATIONS   
 

 Setting up adherence counseling forum 
where patients are counseled on the 
importance of adherence 

 Creating adherence monitoring team 
among the patients where they help 
remind each other through phone 
communications 

 Effective management of depression 
where patients learn to see themselves as 
not lesser than those who are not     
infected  

 Setting up of ART alert in Global System 
Mobile (GSM) phones of patients  

 Ensuring sustained availability and 
accessibility of drugs at no cost in public 
HIV care units  

CONSENT AND ETHICAL APPROVAL 
 
Permission to carry out the investigation was 
obtained from the Ondo State Ministry of Health, 
after thorough scrutiny of the research proposal 
by the ethical approval committee of the Ministry. 
Patients’ consent were individually sought before 
their enrollment into the study. 

 
COMPETING INTERESTS 
 
Authors have declared that no competing 
interests exist. 

 
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