Clinical and health system factors associated with antiretroviral therapy adherence among people living with HIV and AIDS: cross-sectional survey insights from three ART facilities in Tamale, Ghana

Abstract

Aim: Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) have attained a manageable chronic status as more infected people experience increases in their life quality and expectancy. Health system factors affect adherence to Antiretroviral Therapy (ART) among persons living with HIV (PLHIV). Nonetheless, literature on health-system factors and ART adherence among PLHIV is sparse. This study therefore aimed to elucidate clinical and health system factors associated with ART adherence among PLHIV in Tamale Metropolis.

Methods: We conducted a facility-based cross-sectional survey of 418 PLHIV in the Tamale Metropolis, selected by convenience sampling from three major ART centres. Each factor associated with ART adherence, considered statistically significant at a p-value of < 0.05 with a 95% confidence interval, was analysed using both binary and multivariate logistic regression. Adherence was assessed by self-report of missed doses in the past 30 days, categorised as good (≥ 95% of prescribed doses taken) or poor (< 95% of prescribed doses taken).

Results: The overall ART adherence rate was 93.1% (95% CI: 90.3%–95.2%). Clinical and health system factors significantly associated with higher adherence included the absence of post-pill fatigue (AOR = 0.09; 95% CI: 0.02–0.37), absence of complaints regarding pill size (AOR = 3.71; 95% CI: 1.23–11.18), lower cost of accessing therapy (AOR = 0.27; 95% CI: 0.10–0.73), uninterrupted ART supply (AOR = 7.76; 95% CI: 1.02–59.30), and strong social support systems (AOR = 6.62; 95% CI: 1.18–37.21).

Conclusions: An adherence rate of 93% was obtained which falls short of the 95% global benchmark. Clinical factors promoting adherence included the absence of fatigue and concerns related to pill size, while health system-related factors promoting adherence included reduced cost of access, consistent ART supply, and good social support. The Ghana AIDS Commission and its implementing partners are urged to strengthen community-based social support networks, expand ART distribution points, and develop targeted educational initiatives to improve therapy adherence and contribute to achieving epidemic control. Limitations of this study include the use of self-reported adherence (potential recall and social desirability bias) and the cross-sectional design, which precludes causal inference.

Keywords

adherence / antiretroviral therapy / HIV&AIDS / Ghana / Tamale Metropolis / health systems

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