Adherence to antiretroviral treatment among HIV positive patients in primary health care in Nampula, Mozambique

Abstract

Objectives: To evaluate adherence to antiretroviral treatment in Nampula province and to identify the determinants of non-compliance. Study type: Observational study with quantitative and qualitative methods. Place: Five health centers in the Nampula province of Mozambique in 2014. Population: Patients infected with human immunodeficiency virus receiving antiretroviral treatment, patients who had abandoned treatment, and primary health care professionals. Methods: Patients on treatment and patients who were non-compliant with therapy completed a questionnaire, patient records (clinical files, pharmacy records, and statistical records) were reviewed, and interviews were conducted with health care professionals. Results: Abandonment of antiretroviral treatment reached 40%. We surveyed 208 patients on treatment and 86 patients who were non-compliant with therapy. Of these 70% were female and they were between 18 and 62 years of age. The main reason for non-compliance with treatment (36%) was stigma attached to having the infection. In addition 58% of patients do not have enough food and 37% suffer from depressive ideation. Good treatment adherence (> 95% of pills were taken in the last three months) was found in 69% of patients, but 36 % of people who are adherent have a low CD4 count and 63% are not following the recommended treatment protocol. Conclusions: Perception of stigma from infection with the human immunodeficiency virus is considered the main reason for non-adherence with antiretroviral treatment, but food insecurity is also an important determinant. A treatment adherence rate of 69% explains the high incidence of opportunistic infections (27%). Abandonment of antiretroviral treatment in Nampula is a serious and complex problem due to individual, social and primary health care services factors. It will be necessary to develop an interdisciplinary intervention with patients, families, and health professionals, to reverse this situation and improve treatment adherence.