Prevalence and determinants of adherence to antiretroviral treatment among HIV patients on first-line regimen: a cross-sectional study in Dakar, Senegal

Abstract

Introduction: successful and long-term positive impact of antiretroviral treatment requires high rates of adherence (> 90%). In Senegal, there is
a lack of data regarding adherence to antiretroviral treatment and only a few studies have looked at the determinants. The aim of this study is to
assess the prevalence and determinants contributing to antiretroviral (ARV) adherence among Human Immunodeficiency Virus (HIV) infected
outpatients receiving care at four public hospitals in Dakar, Senegal. Methods: a cross-sectional based study was carried out among HIV-positive
ART adults in Dakar, Senegal. Patients were systematically sampled during either their clinical visits or visit to collect ARV drugs from six public
hospitals and data collected with a questionnaire. The study outcome was adherence to antiretroviral treatment assessed by a multiple approach
method which combined three self-reported adherence tools: self-reporting, Visual Analog Scale (VAS), and the Simplified Medication Adherence
Questionnaire (SMAQ). Data were entered with an Excel spreadsheet and transferred to STATA for descriptive, bivariate and multivariate analysis.
All the statistical tests were done at the threshold level of 0.05. Results: a total of 150 HIV-positive patients on first line ART regimen at six public
health facilities were enrolled into the study. The mean age of patients was 43.1 years with a sex ratio of 0.3. Most of the patients were prescribed
Tenofovir-based regimen. Of these patients, 26.67% were found to be highly adherent. After adjusting for health-related variables, demographic
and socio-economic variables, better adherence was associated with participating actively within an association of persons living with HIV (AoR=2.89;
95% CI: 1.04 - 7.99; p value 0.041) while being widowed patient was associated with lower adherence (AoR=0.17; 95% CI: 0.03 - 0.94; p value
0.043). Conclusion: our study findings imply that adherence should be routinely assessed during medical visits. Ongoing strategies to improve
adherence such as out-of-clinic group-based models or psychological support should be directed toward outpatients' clinics to assist in improving
adherence and long term virologic suppression in Senegal.