Adherence to antiretroviral drugs among AIDS patients in Sagamu, Nigeria

Adherence to drug therapy is crucial for drug efficacy and prevention of drug resistance. A crosssectional study of 53 patients (40 receiving free medication and 13 on self purchased drugs) attending the Center for Special Studies clinic in Sagamu, Nigeria between September 1 and November 30, 2003 was carried out to determine the level of adherence and the factors associated with non adherence. Only patients who had been on ARV for at least 3 months were recruited into the study. An interview administered questionnaire was used to collect data on 7 day recall of drug use. The cost of a fixed combination of Nevirapine, zidovudine (AZT) and Epivir (3TC) is between $75-80. There were 21 males and 32 females giving a male: female ratio of 1:1.5. The mean age of respondents was 40.5 years; the majority were Christians (79.2%), married (47.2%), and of lower socio-economic status (77.3%). The mean duration of use of ARV drugs was 20.3 months while the mean CD4 count was 262cells/ul. Overall, 79.2% achieved an adherence level of 95%. This optimal adherence rate was higher in the free-medication subset compared with the selfpurchased subset, although the difference was not statistically significant. [34 (85%) against 8 (61.5%); X2=3.28; P=0.069)]. The most common reason for non adherence was the inability to afford the drugs. Socio-demographic variables, number of pills/day were not significant predictors of non-adherence. Adherence to HAART treatment is high in the study population. The cost of the drugs was the most important reason given for non-adherence. Governments of resource-poor countries and the pharmaceutical industry should explore ways to subsidize the cost of ARV so that PLWHAs can have access to ARV and improve adherence.