Determinants of adherence to antiretroviral therapy among people living with HIV receiving care in health facilities in Tamale Metropolis, Ghana

Abstract

Abstract Background Strictly following antiretroviral therapy (ART) is essential in managing HIV and AIDS and attaining viral suppression. However, adherence to ART remains a complex challenge among persons living with HIV (PLHIV) and it is influenced by various individual and socio-cultural factors. Also, there is limited data as far as the studies on determinants of ART adherence in the Tamale Metropolis is concerned. This highlights a critical knowledge gap that needs to be addressed to improve adherence rates. This study therefore aims to examine the determinants of ART adherence among PLHIV in the Tamale Metropolis, Ghana. Methods A facility-based cross-sectional study design was conducted from November 2023 to February 2024 to recruit 418 PLHIV using consecutive sampling from three healthcare facilities located in the Tamale Metropolis. Data were collected on demographic characteristics, adherence behaviours and socio-cultural beliefs. Every element impacting adherence to ART underwent assessment using a 4-point Likert scale, with data entry and coding executed using Microsoft Excel, followed by statistical analyses using SPSS version 21. Fisher’s exact test, Chi-square test and multiple logistic regression analyses were utilized to ascertain autonomous indicators of ART adherence while accounting for the impact of other factors. Determinants of ART were considered statistically significant at a p-value of less than 0.05 with a 95% confidence interval. Results A total of 418 PLHIV were studied, yielding a 100% response rate and an ART adherence rate of 93%, with a 95% confidence interval ranging from 90.6% to 95.4%. Clients who were educated (AOR = 6.80, 95% CI: 1.57–29.42, p = 0.010), retentive (AOR = 10.73, 95% CI: 4.24–27.15, p < 0.001), had aversion for alternative treatment modalities (AOR = 8.04, 95% CI: 2.90–22.29, p < 0.001) and involved with peer support groups (AOR = 3.73, 95% CI: 1.02–13.56, p < 0.05) exhibited markedly higher rates of adherence to ART, as relative to those who did the opposite. Conclusion The study identified a sub-optimal adherence rate of 93% among PLHIV with key determinants of ART adherence. Among individual factors, educational attainment and forgetfulness played a significant role in influencing adherence levels. In terms of sociocultural factors, inclinations toward alternative therapies, such as traditional or herbal remedies, and active engagement in peer support networks were found to impact adherence. The Ghana AIDS Commission and its partners should implement targeted educational programs, interventions such as reminder systems (e.g., mobile phone alerts, pill organizers) should be developed and promoted, develop culturally sensitive outreach programs that respect traditional beliefs while promoting the benefits of ART and strengthen peer support networks.

Keywords

• Adherence
• Antiretroviral Therapy
• HIV and AIDS
• Ghana
• Tamale Metropolis
• Socio-cultural factors