Adherence to antiretroviral therapy in Nigeria: an overview of research studies and implications for policy and practice

Emmanuel Monjok¹, Andrea Smesny¹, Ita B Okokon², Osaro Mgbere³, E James Essien¹

¹Institute of Community Health, University of Houston, Texas Medical Center, Houston Texas 77030, USA; ²Department of Family Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria; ³Bureau of Epidemiology, Houston Department of Health and Human Services, Houston, Texas 77054, USA

Abstract: Both Human Immunodeficiency Virus (HIV) infection and AIDS remain major public health crises in Nigeria, a country which harbors more people living with HIV/AIDS than any country in the world, with the exception of South Africa and India. In response to the HIV pandemic, global and international health initiatives have targeted several countries, including Nigeria, for the expansion of antiretroviral therapy (ART) programs for the increasing number of affected patients. The success of these expanded ART initiatives depends on the treated individual’s continual adherence to antiretroviral (ARV) drugs. Thirteen peer-reviewed studies concerning adherence to ART in Nigeria were reviewed with very few pediatric and adolescent studies being found. Methodologies of adherence measurement were analyzed and reasons for nonadherence were identified in the geopolitical zones in the federal republic of Nigeria. The results of the literature review indicate that adherence to ART is mixed (both high and low adherence) with patient self-recall identified as the common method of assessment. The most common reasons identified for patient nonadherence include the cost of therapy (even when the drugs are heavily subsidized), medication side effects, nonavailability of ARV drugs, and the stigma of taking the drugs. This manuscript highlights the policy and practice implications from these studies and provides recommendations for future ART program management.

Keywords: adherence, antiretroviral therapy (ART), HIV, PLWHA, Nigeria