The success of antiretroviral treatment (ART) depends on adherence. Adherence is necessary to reduce the risk of resistance, restore immunity, and reduce incidence, morbidity and mortality. Data on the ratio of refugees and conflict-affected people living with HIV and on ART needs are scarce. The objective of this study is to identify barriers to ART adherence among refugees living with HIV/AIDS in Douala. In a cross-sectional, analytical study conducted among refugees living with HIV/AIDS in Douala and followed in health facilities that are partners of the High Commissioner for Refugees (HCR). Adherence was evaluated on the basis of patient declarations (declared adherence) and the regularity of the renewal of their prescriptions (calculated adherence). The quantitative data collected with the anonymous questionnaire administered after informed consent was entered with Epi Info version 7.1.3.0. Descriptive and inferential analysis was carried out with SPSS version 17.0, which allowed us to determine the association between predisposing factors and adherence to antiretroviral treatment using Pearson's Chi-square test. 200 refugees meeting our inclusion criteria were interviewed. The average length of follow-up was 4 years. The average age was 40.66 ± 9.35 years and the sex ratio was 2.39 in favour of the female sex. 91.5% of the refugees had started treatment more than a year ago. The level of reported compliance was significantly lower than the overall level of calculated compliance (67.5% vs. 71.0%, P=0.000). The main obstacles to adherence were forgetting and lack of food. People who received accurate information about their illness were more observant (P=0.000). Adherence to antiretroviral treatment was best when the year of initiation of treatment was two years or more (P=0.000) and the patient knew the duration of treatment (p=0.000). The low adherence rate (<95%) among refugees was related to several factors. The difference observed between the results of the two methods used to estimate adherence shows us the need for biological methods in assessing the level of treatment adherence. Measures will be needed to improve the level of adherence among refugees, including the strengthening of psycho-social support.
| Published in | International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 10, Issue 2) |
| DOI | 10.11648/j.ijhpebs.20241002.11 |
| Page(s) | 45-56 |
| Creative Commons |
This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
| Copyright |
Copyright © The Author(s), 2024. Published by Science Publishing Group |
Adherence to Treatment, Refugees, Antiretroviral Treatment, HIV/AIDS
Variables | Numbers (n) | Frequencies (%) |
|---|---|---|
Age (Year) | ||
<= 30 years old | 32 | 16 |
31-50 years old | 133 | 66.50 |
51-60 years old | 31 | 15.50 |
> 60 years old | 4 | 2 |
Nationality | ||
Central African Republic | 175 | 87.50 |
Congolese | 15 | 7.50 |
Malian | 3 | 1.50 |
Chadian | 5 | 2.50 |
Ivorian | 2 | 1 |
Sex | ||
Men | 59 | 29.50 |
Women | 141 | 70.50 |
Marital status Cohabitation | 95 | 42.5 |
Widow (er) | 55 | 27.5 |
Married | 50 | 25 |
Divorced | 10 | 5 |
Occupation Worker | 60 | 30 |
Agent | 40 | 20 |
Small trades | 65 | 32.50 |
Unemployed | 35 | 17.50 |
Level of education | ||
None | 25 | 12.5 |
Primary | 85 | 42.5 |
Secondary | 60 | 30 |
University | 30 | 15 |
Total | 200 | 100 |
Variables | Non-Compliance n (%) | Compliance n (%) | Total N (%) | p |
|---|---|---|---|---|
Sex | ||||
Male | 28 (14%) | 31 (15.50%) | 59 (29.50%) | 0.003 |
Female | 37 (18.50%) | 104 (52 %) | 141 (70.50%) | |
Marital status | ||||
Married | 12 (6%) | 23 (11.50%) | 35 (17.50%) | 0.043 |
Single | 34 (17%) | 50 (25%) | 84 (42%) | |
Widow (widower) | 8 (4%) | 44 (22%) | 52 (26%) | |
Divorced | 4 (2%) | 7 (3.50%) | 11 (5.50%) | |
Cohabitation | 7 (3.50%) | 11 (5.50%) | 18 (9%) | |
Year of HIV diagnosis | ||||
[6 months -1 year] | 10 (5%) | 8 (4%) | 18 (9%) | 0.018 |
]1 year - 1 year 6month] | 6 (3%) | 5 (2.50%) | 11 (9%) | |
]1 year 6 months - 2years] | 13 (6.50%) | 20 (10%) | 33 (16.50%) | |
> 2 years | 36 (18%) | 102 (51%) | 138 (69%) | |
Year of initiation of treatment | ||||
[6 months -1 year] | 11 (5.50%) | 8 (4%) | 18 (9%) | 0.013 |
]1 year - 1 year - month] | 5 (2.50%) | 5 (2.50%) | 11 (9%) | |
]1 year - 6 months-2years] | 14 (7%) | 21 (10.50%) | 33 (16.50%) | |
> 2 years | 35 (17.50%) | 101 (50.50%) | 138 (69%) | |
Total | 65 (32.50%) | 135 (7.50%) | 200 (100%) |
Variables | Non-Compliance n (%) | Compliance n (%) | Total N (%) | p |
|---|---|---|---|---|
More than one catch in the last 4 days | ||||
Yes | 29 (14.50%) | 9 (4.50%) | 38 (19%) | |
No | 36 (3%) | 126 (63%) | 162 (81%) | 0.018 |
Jump more than 2 catches in the last 10 days | ||||
Yes | 36 (18%) | 15 (7.50%) | 51 (25.50%) | |
No | 29 (14.50%) | 120 (60%) | 20(74.50%) | 0.000 |
Forgetting to take it for a week or more since the beginning of the treatment | ||||
Yes | 50 (25.50%) | 44 (22%) | 47 (47%) | |
No | 15 (7.50%) | 91 (45.50%) | 106 (53%) | 0.000 |
Respect of the last 3 appointments given | ||||
Yes | 31 (15.50%) | 133 (66.50%) | 164 (82%) | 0.000 |
No | 34 (17%) | 2 (1%) | 36 (18%) | |
Receipt of accurate information about the disease | ||||
Yes | 33 (16.50%) | 97 (48.50%) | 130 (9%) | |
No | 32 (16.50%) | 38 (19%) | 70 (35%) | 0.003 |
Importance of treatment | ||||
Yes | 38 (19%) | 125 (62.50%) | 163 (81%) | 0.000 |
No | 27 (13.50%) | 10 (5%) | 37 (18.50%) | |
Duration of treatment | ||||
6 months | 2 (1%) | 1 (31%) | 3 (1.50%) | |
1 year | 1 (0.50%) | 0 (0%) | 1 (0.50%) | 0.000 |
Don't know | 47 (23.50%) | 49 (24.50%) | 96 (48%) | |
All your life | 15 (7.50%) | 85 (42.50%) | 100 (50%) | |
Knowledge of the side effects of ART | ||||
Yes | 23 (11.50%) | 93 (15%) | 116 (25.50%) | 0.000 |
No | 42 (21%) | 42 (21%) | 84 (42%) | |
Improved health since taking ART | ||||
Aggravation | 1 (0.50%) | 2 (1%) | 3 (1.50%) | |
No improvement | 2 (1%) | 0 (0%) | 2 (1%) | |
Slight improvement | 19 (9.5%) | 5 (2.5%) | 24 (12%) | 0.003 |
Marked improvement | 42 (21%) | 126 (63%) | 168 (84%) | |
Don't know | 1 (1%) | 2 (1%) | 3 (1.50%) | |
Staff availability | ||||
Yes | 44 (22%) | 122 (61%) | 166 (83%) | 0.000 |
No | 21 (10.50%) | 13 (6.50%) | 34 (17%) | |
Number of tablets taken | ||||
Acceptable | 52 (26%) | 118 (59%) | 170 (85%) | 0.361 |
Excessive | 1 (0.50%) | 2 (1%) | 3 (1.50%) | |
Don't know | 12 (6%) | 15 (7.50%) | 27 (13.50%) | |
Importance of treatment | ||||
Yes | 38 (19%) | 125 (62.50%) | 163 (81%) | 0.000 |
No | 27 (13.50%) | 10 (5%) | 37 (18.50%) | |
Associative support | ||||
Yes | 3 (1.50%) | 26 (13%) | 29 (14.50%) | 0.003 |
No | 62 (31%) | 109 (54.50%) | 145 (85.50%) | |
Alcohol consumption | ||||
Yes | 26 (13%) | 29 (14.50%) | 55 (27.50%) | 0.006 |
No | 39 (19.50%) | 106 (53%) | 145 (72.50%) | |
Problem swallowing some tablets | ||||
Yes | 21 (10.50%) | 20 (11.50%) | 41 (20.50%) | 0.004 |
No | 44 (22%) | 115 (56%) | 159 (79.50%) | |
Follow-up of another treatment | ||||
Yes | 25 (12.50%) | 23 (11.50%) | 48 (24%) | 0.001 |
No | 40 (20%) | 112 (56%) | 152 (76%) | |
Opportunistic affections | ||||
Tuberculosis | 11 (5.50%) | 12 (6%) | 23 (11.50%) | 0.192 |
Toxoplasmosis | 1 (0.50%) | 0 (0%) | 1 (0.50%) | |
Application | 10 (5%) | 8 (4%) | 18 (9%) | |
None | 43 (21.50%) | 115 (57.50%) | 158 (79%) | |
Viral load production | ||||
Yes | 36 (18%) | 105 (52.50%) | 141 (70.50%) | 0.001 |
No | 29 (14.50%) | 30 (15.50%) | 59 (29.50%) | |
Making CD4 | ||||
Yes | 12 (6%) | 41 (20.50%) | 53 (26.50%) | 0.051 |
No | 53 (26.50%) | 94 (47%) | 147 (73.50%) | |
Total | 65 (32.50%) | 135 (67.50%) | 200 (100%) |
Variables | Non-Compliance n (%) | Compliance n (%) | Total N (%) | p |
|---|---|---|---|---|
Age (years) | ||||
<= 30 years old | 14 (7%) | 18 (9%) | 32 (16%) | |
31-50 years old | 41 (20.50%) | 92 (46%) | 133 (66.50%) | 0.010 |
51-60 years old | 2 (1%) | 29 (14.50%) | 31 (15.50%) | |
>60 years old | 1 (0.50%) | 3 (1.50%) | 4 (2%) | |
Sex | ||||
Male | 20 (10%) | 39 (19.50%) | 59 (29.50%) | 0.323 |
Female | 38 (19%) | 103 (51.50%) | 142 (70.50%) | |
Marital status | ||||
Married | 5 (2.50%) | 30 (15%) | 35 (17.50%) | |
Single | 33 (16.50%) | 51 (25.50%) | 84 (42%) | |
Widow (widower) | 6 (3%) | 46 (23%) | 52 (26%) | 0.000 |
Divorced | 5 (2.50%) | 6 (3%) | 11 (5.50%) | |
Cohabitation | 9 (4.50%) | 9 (4.50%) | 18 (9%) | |
Source of income | ||||
Salary | 4 (2.50%) | 13 (6.50%) | 17 (8.50%) | |
Agriculture | 30 (15%) | 66 (33%) | 96 (48%) | |
Third party support | 2 (1%) | 21 (10.50%) | 23 (11.50%) | 0.002 |
UNHCR Assistance | 0 (0%) | 16 (8%) | 16 (8.50%) | |
None | 22 (11%) | 25 (12.50%) | 47 (23.50%) | |
Other | 0 (0%) | 1 (0.50%) | 1(0.50%) | |
Number of tablets taken | ||||
Acceptable | 52 (26%) | 118 (59%) | 170 (85%) | |
Excessive | 1 (0.50%) | 2 (1%) | 3 (1.50%) | 0.361 |
Don't know | 12 (6%) | 15 (7.50%) | 27 (13.50%) | |
Importance of treatment | ||||
Yes | 29 (14.50%) | 134 (67%) | 163 (81%) | 0.000 |
No | 29 (14.50%) | 8 (4%) | 37 (18.50%) | |
Duration of treatment | ||||
6 months | 0 (0%) | 3 (1.50%) | 3 (1.50%) | |
1 year | 0 (0%) | 1 (0.50%) | 1 (0.50%) | |
Don't know | 54 (27%) | 42 (21.50%) | 96 (48%) | 0.000 |
All your life | 4 (2%) | 96 (48%) | 100 (50%) | |
Associative support | ||||
Yes | 0 (0%) | 29 (14.50%) | 29 (14.50%) | 0.000 |
No | 58 (29%) | 113 (56.50%) | 145 (85.50%) | |
Alcohol consumption | ||||
Yes | 26 (13%) | 29 (14.50%) | 55 (27.50%) | 0.001 |
No | 32 (16%) | 113 (56.50%) | 145 (72.50%) | |
Problem swallowing some tablets | ||||
Yes | 23 (11.50%) | 18 (9%) | 41 (20.50%) | 0.000 |
No | 35 (17.50%) | 124 (62%) | 159 (79.50%) | |
Follow-up of another treatment | ||||
Yes | 31 (15.50%) | 17 (8.50%) | 48 (24%) | 0.000 |
No | 27 (13.50%) | 125 (62.50%) | 152 (76%) | |
Always eat before taking ART | ||||
Yes | 6 (3%) | 82 (41%) | 88 (44%) | 0.000 |
No | 52 (26.50%) | 60 (30%) | 112 (56%) | |
Disruptive events after taking ART | ||||
Yes | 51 (25.50%) | 70 (35%) | 121 (60.50%) | 0.000 |
No | 7 (3.50%) | 72 (36%) | 79 (39.50%) | |
Perception of the benefit of the treatment | ||||
Yes | 29 (14.50%) | 132 (66%) | 161 (80.50%) | 0.000 |
No | 29 (14.50%) | 10 (5%) | 39 (19.50%) | |
Knowledge of the risks of non-compliance | ||||
Yes | 24 (12%) | 117 (58.50%) | 141 (70.50%) | 0.000 |
No | 34 (17%) | 25 (12.50%) | 59 (29.50%) | |
Relationship with staff | ||||
Good | 28 (14%) | 121 (60.50%) | 149 (74.50%) | 0.005 |
Average | 29 (14.50%) | 20 (10%) | 49 (24.50%) | |
Wrong | 1 (0.50%) | 1 (0.50%) | 2 (1%) | |
Opportunistic affections | ||||
Tuberculosis | 15 (7.50%) | 8 (4%) | 23 (11.50%) | |
Toxoplasmosis | 1 (0.50%) | 0 (0%) | 1 (0.50%) | 0.000 |
Application | 6 (3%) | 12 (6%) | 18 (9%) | |
None | 36 (18%) | 122 (61%) | 158 (79%) | |
Total | 58 (29%) | 142 (71%) | 200 (100%) |
AHTC | Accredited HIV/AIDS Treatment Center |
ART | Antiretroviral Therapy (ART) |
CU | Care Units |
CDC | Center Control Diseases |
DLH | Douala Laquintinie Hospital |
HIV | Human Immuno Deficiency Virus |
HCR | High Commissioner for Refugees |
UNAIDS | United Nation Acquire Immuno Deficiency Syndrom |
UNHCR | United Nations High Commissioner for Refugees |
WHO | World Health Organisation |
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APA Style
Bruno, E. S., Rodrigue, Y., Robert, T. T., Nsongmayi, E. D., Isabelle, L., et al. (2024). Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 10(2), 45-56. https://doi.org/10.11648/j.ijhpebs.20241002.11
ACS Style
Bruno, E. S.; Rodrigue, Y.; Robert, T. T.; Nsongmayi, E. D.; Isabelle, L., et al. Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2024, 10(2), 45-56. doi: 10.11648/j.ijhpebs.20241002.11
AMA Style
Bruno ES, Rodrigue Y, Robert TT, Nsongmayi ED, Isabelle L, et al. Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon. Int J HIV/AIDS Prev Educ Behav Sci. 2024;10(2):45-56. doi: 10.11648/j.ijhpebs.20241002.11
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Download@article{10.11648/j.ijhpebs.20241002.11,
author = {Ebong Serge Bruno and Yemene Rodrigue and Tefe Tagne Robert and Ekwi Damian Nsongmayi and Lendem Isabelle and Mballa Amougou Jean Claude and Nke Martine and Edima Hélène Carole and Mbebi Enone Juste Patient and Bika Claude and Adiogo Dieudonné and Eboumbou Else Carole},
title = {Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon
},
journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
volume = {10},
number = {2},
pages = {45-56},
doi = {10.11648/j.ijhpebs.20241002.11},
url = {https://doi.org/10.11648/j.ijhpebs.20241002.11},
eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20241002.11},
abstract = {The success of antiretroviral treatment (ART) depends on adherence. Adherence is necessary to reduce the risk of resistance, restore immunity, and reduce incidence, morbidity and mortality. Data on the ratio of refugees and conflict-affected people living with HIV and on ART needs are scarce. The objective of this study is to identify barriers to ART adherence among refugees living with HIV/AIDS in Douala. In a cross-sectional, analytical study conducted among refugees living with HIV/AIDS in Douala and followed in health facilities that are partners of the High Commissioner for Refugees (HCR). Adherence was evaluated on the basis of patient declarations (declared adherence) and the regularity of the renewal of their prescriptions (calculated adherence). The quantitative data collected with the anonymous questionnaire administered after informed consent was entered with Epi Info version 7.1.3.0. Descriptive and inferential analysis was carried out with SPSS version 17.0, which allowed us to determine the association between predisposing factors and adherence to antiretroviral treatment using Pearson's Chi-square test. 200 refugees meeting our inclusion criteria were interviewed. The average length of follow-up was 4 years. The average age was 40.66 ± 9.35 years and the sex ratio was 2.39 in favour of the female sex. 91.5% of the refugees had started treatment more than a year ago. The level of reported compliance was significantly lower than the overall level of calculated compliance (67.5% vs. 71.0%, P=0.000). The main obstacles to adherence were forgetting and lack of food. People who received accurate information about their illness were more observant (P=0.000). Adherence to antiretroviral treatment was best when the year of initiation of treatment was two years or more (P=0.000) and the patient knew the duration of treatment (p=0.000). The low adherence rate (<95%) among refugees was related to several factors. The difference observed between the results of the two methods used to estimate adherence shows us the need for biological methods in assessing the level of treatment adherence. Measures will be needed to improve the level of adherence among refugees, including the strengthening of psycho-social support.
},
year = {2024}
}
TY - JOUR T1 - Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon AU - Ebong Serge Bruno AU - Yemene Rodrigue AU - Tefe Tagne Robert AU - Ekwi Damian Nsongmayi AU - Lendem Isabelle AU - Mballa Amougou Jean Claude AU - Nke Martine AU - Edima Hélène Carole AU - Mbebi Enone Juste Patient AU - Bika Claude AU - Adiogo Dieudonné AU - Eboumbou Else Carole Y1 - 2024/12/09 PY - 2024 N1 - https://doi.org/10.11648/j.ijhpebs.20241002.11 DO - 10.11648/j.ijhpebs.20241002.11 T2 - International Journal of HIV/AIDS Prevention, Education and Behavioural Science JF - International Journal of HIV/AIDS Prevention, Education and Behavioural Science JO - International Journal of HIV/AIDS Prevention, Education and Behavioural Science SP - 45 EP - 56 PB - Science Publishing Group SN - 2575-5765 UR - https://doi.org/10.11648/j.ijhpebs.20241002.11 AB - The success of antiretroviral treatment (ART) depends on adherence. Adherence is necessary to reduce the risk of resistance, restore immunity, and reduce incidence, morbidity and mortality. Data on the ratio of refugees and conflict-affected people living with HIV and on ART needs are scarce. The objective of this study is to identify barriers to ART adherence among refugees living with HIV/AIDS in Douala. In a cross-sectional, analytical study conducted among refugees living with HIV/AIDS in Douala and followed in health facilities that are partners of the High Commissioner for Refugees (HCR). Adherence was evaluated on the basis of patient declarations (declared adherence) and the regularity of the renewal of their prescriptions (calculated adherence). The quantitative data collected with the anonymous questionnaire administered after informed consent was entered with Epi Info version 7.1.3.0. Descriptive and inferential analysis was carried out with SPSS version 17.0, which allowed us to determine the association between predisposing factors and adherence to antiretroviral treatment using Pearson's Chi-square test. 200 refugees meeting our inclusion criteria were interviewed. The average length of follow-up was 4 years. The average age was 40.66 ± 9.35 years and the sex ratio was 2.39 in favour of the female sex. 91.5% of the refugees had started treatment more than a year ago. The level of reported compliance was significantly lower than the overall level of calculated compliance (67.5% vs. 71.0%, P=0.000). The main obstacles to adherence were forgetting and lack of food. People who received accurate information about their illness were more observant (P=0.000). Adherence to antiretroviral treatment was best when the year of initiation of treatment was two years or more (P=0.000) and the patient knew the duration of treatment (p=0.000). The low adherence rate (<95%) among refugees was related to several factors. The difference observed between the results of the two methods used to estimate adherence shows us the need for biological methods in assessing the level of treatment adherence. Measures will be needed to improve the level of adherence among refugees, including the strengthening of psycho-social support. VL - 10 IS - 2 ER -
Unit of Physiology and Medicine of Physical and Sports Activities, University of Douala, Douala, Cameroon;Department of Public health, Institute of Health Applied Sciences, Douala, Cameroon;Department of Biomedical and Medical Sciences, University of Ebolowa, Ebolowa, Cameroon
Department of Public health, Institute of Health Applied Sciences, Douala, Cameroon
Department of Sociology, University of Douala, Douala, Cameroon
Department of Biomedical and Medical Sciences, University of Ebolowa, Ebolowa, Cameroon
Department of Biomedical and Medical Sciences, University of Ebolowa, Ebolowa, Cameroon
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