Title page
List of acronyms

Chapter One - Introduction
1.1       Background
1.2       Problem Statement
1.3       Rational/Justification
1.4       Research Question
1.5       Objectives

Chapter Two - Literature Review
2.1       Conceptual framework
2.2       Proportion of HIV patients with poor adherence
2.3       Knowledge about ART among HIV/AIDS patients
2.4       Socio-demographic factors that influence adherence to ART
2.5       Patient-provider related factors
2.6       Method/design in previous adherence studies
2.7       Gaps in knowledge and further justification

Chapter Three - Methodology
3.1       Study area
3.2       Study design
3.3       Study period
3.4       Study population
3.5       Sampling size determination
3.6       Sampling techniques
3.7       Study instruments
3.8       Data collection methods
3.9       Data management and analysis
3.10     Ethical clearance
3.11     Limitations
3.12     Scope of the study

Chapter Four - Results
4.1       Socio-demographic characteristic of study population
4.2       Proportion of poor adherence
4.3       Knowledge on anti-retroviral drugs (ART)
4.4       Patient-provider related factors

Chapter Five - Discussion

Chapter Six - Conclusion and Recommendations
6.1       Conclusion
6.2       Recommendations

HIV has remained a major public health problem despite huge financial resources expended by stakeholders at finding cure and mitigating the impact of the disease. With the global estimate of 34 million people living with the virus and 2.5 million new infections, Nigeria ranks second among HIV/AIDS burdened countries with a prevalence of 4.1% and estimated 3.2 million people living with the disease. In spite free HIV treatment in Nigeria, poor adherence to Antiretroviral Therapy has continued to pose a greater challenge to achieving remarkable clinical and immunological outcomes due to ARV drug resistance. This study identified factors associated with poor adherence to antiretroviral drugs among patients accessing care at Nigeria Institute of Medical Research, Lagos, Nigeria.
A cross-sectional study was conducted from January 1st to March 31st, 2014 on HIV-infected aged ≥ 15 years being on treatment with antiretroviral drugs three months prior to commencement of study. Data were collected using semi-structured questionnaires to obtain information on patients‟ adherence level, knowledge on ART, socio-demographics and provider-patient related factors. Data were subsequently entered and analyzed in Epi Info version 3.5.1 for descriptive statistics and to calculate odds ratios and adjusted odds ratios to identify the relative effect of explanatory variables on the dependent variable. A qualitative study was also carried out to further explore factors associated with poor adherence.

Of the 426 patients interviewed, 285 (66.9%) were female; mean age 39.3(±SD) of 8.9 years and out of 112 (26.3%) who had poor adherence, 70 (62.5%) were females and 40 (37.5%) were males. Poor adherence were associated with not receiving adherence counselling (OR 5.1; CI 95%: 2.1 – 13.5) unsatisfactory attitude of health workers (OR 4.8; CI 95%: 1.8 – 12.7), undergoing adherence counselling sessions of less than three times (OR 2.1; CI 95%: 1.2 – 3.9), and receiving counselling from non-health workers (OR 11.1; CI 95%: 1.2 – 100.2). Major reasons for poor adherence were forgetfulness (47.7%), and frequent travelling (9.2%). FGD revealed poor attitude of the health workers and stigma and discrimination as barriers to adherence to treatment. Multivariate analysis revealed unsatisfactory attitude of health workers (AOR 4.8, p-value 0.01), undergoing adherence counselling sessions of less than three times (AOR 2.1, p-value 0.01) and receiving adherence counselling from non-health workers (AOR 10.9, p-value 0.03) as independent factors associated with poor adherence to ART.

The study revealed receiving adherence counselling, attitude of health workers, number of counselling sessions received and whether counselling was given by health worker as the major determinants of adherence to anti-retroviral treatment. On-the-job training for Health workers on attitudinal change and improving adherence by providing regular follow-up, increasing patients‟ awareness of the ART treatment, including its benefits and side-effects, eliminating problems of access and alleviating the impact of cost by making all drugs available was included in the routine supportive supervision.

1.1         Background
Joint United Nation Program for HIV/AIDS estimated that between 31.4 million and 35.9 million people are currently living with HIV/AID worldwide of which 4.8 million are in Asia (China;78 0,000, Thailand; 490,000 and Indonesia; 380,000), 490,000 in Latin America (Brazil; 490,000), 2.3 million in North America, Western and Central Europe, 1.3 million in USA, 53,000 in Oceania, 230,000 in Caribbean, 300,000 in Middle East and North Africa and 23.5 million in Sub-Sahara Africa (Tanzania; 1.6 million, South Africa; 5.6 million, Uganda; 1.4 million, Zambia; 970,000, Zimbabwe; 1.2 million, Kenya; 1.6 million, Ethiopia; 790,000 and Nigeria; 3.1 million). The number of AIDS-related death was reported to be 1.7 million and 2.5 million were due to new infections. Out of 14.8 million persons eligible for HIV treatment, only approximately 54% are on ARV treatment.1

In the last ten years (2001-2011) the landscape of national HIV epidemics has changed dramatically, for the better in most countries, especially in sub-Saharan Africa where 69% of HIV/AIDS cases live. Countries are making historic gains towards ending the AIDS epidemic: 700 000 fewer new HIV infections across the world in 2011 than in 2001.1

Nigeria with estimated population of 173, 611, 131 and growth rate of 3.2% 2,3has a current HIV prevalence of 4.1% with about 3.2 million infected with the virus and estimated 1.6 million eligible for Anti-retroviral drugs.4 With estimated 34% of the general population accessing basic health care, the epidemic is more ravaging in the rural...

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