Psycho–demographic Variables and Adherence to Anti-retroviral Therapy Among People Living With Hiv/aids in Akwa Ibom North East Senatorial District
CHAPTER ONE
Purpose of the Study
This study seek is to find out the determinants of adherence to anti-retroviral therapy among the people living with HIV and AIDS in Akwa Ibom State.
Specifically, the study seeks;
- To determine the influence of age on adherence to antiretroviral therapy among people living with HIV and AIDS in Akwa Ibom State.
- To ascertain the influence of gender on adherence to antiretroviral therapy among people living with HIV and AIDS in Akwa Ibom State.
- To find out the influence of marital status on adherence to antiretroviral therapy among people living with HIV and AIDS in Akwa Ibom State.
- To determine the influence of educational level on adherence to antiretroviral therapy among people living with HIV and AIDS in Akwa Ibom State.
- To ascertain the influence of religion on adherence to antiretroviral therapy among people living with HIV and AIDS in Akwa Ibom State.
- To determine the influence of depression on adherence to antiretroviral therapy among people living with HIV and AIDS in Akwa Ibom State.
- To find out the influence of stigmatization on adherence to antiretroviral therapy among people living with HIV and AIDS in Akwa Ibom State.
- To ascertain the influence of accessibility of health care on adherence to anti-retroviral therapy among people living with HIV and AIDS in Akwa Ibom State.
CHAPTER TWO
Review of Related Literature
Literature abounds on the issue of HIV and AIDS on the determinants of adherence to antiretroviral therapy. The review of literature will be discussed on the major sub-themes of the topic based on theoretical, conceptual and empirical framework.
Theoretical Framework
- Health Belief Model – by I. M Rosenstock, G. M. Hochbaum, S. S. Kegeles, and H. Leventhal in 1950s
- Social Ecological Framework –
- Trans Theoretical Model of Change – by Diclemente and Prochaska in 1977
Conceptual Framework
- The concept of HIV and AIDS
- The concept of Adherence
- Types of Antiretroviral Therapies
- Measuring Adherence to Antiretroviral Therapy
Determinants of Adherence to ART
- Age
- Gender
- Education
- Marital status
- Religion
- Stigmatization
- Patient’s depressive state
- Accessibility of health care
Theoretical Framework
The Health Belief Model (HBM) – 1950s by I. M Rosenstock, G.M Hochbaum, S.S. Kegeles, and Howard Leventhal.
The Health Belief Model (HBM) is a psychological model that attempts to explain and predict health behaviours by focusing on the attitudes and beliefs of individuals. This model was developed in the 1950s as part of an effort by social psychologist on the United States Public Health Services to explain the lack of public participation in health screening and prevention programmes. Rosenstock, Stretcher and Becker (1994) explained the key variables to include;
- Perceived threat which include susceptibility and perceived severity of a health condition
- Perceived susceptibility – one’s subjective perception of the risk of a health condition.
- Perceived severity – feeling concerning the seriousness of contacting an illness or of leaving it untreated.
- Perceived benefit – the belief effectiveness of strategies designed to reduce the threat of illness.
- Perceived barriers – the potential negative consequences that may result from taking a particular health action, including physical, psychological and financial demand.
- Cues to Action – Events either bodily or environmental that motivates people to take action.
CHAPTER THREE
Research Method
The organization of this chapter is done under the following subheadings, namely; Research design, area of study, sampling technique, instrument for data collection, methods of data collection and analysis.
Research Design
An expo-facto research design was adopted for the study. This was considered appropriate since the researcher had no direct control of the independent variables because their manifestation has already occurred and cannot be manipulated.
Area of the Study
The area of this study is Akwa Ibom North East Senatorial District. It lies between latitude 4º 4o’ and 5º 22’ North of the Equator and between 7º 47’ and 8º 1o’ of the Greenwich Meridian. It is one of the three senatorial districts of Akwa Ibom State located in the Niger Delta region of Nigeria and made up of nine Local Government Areas (see appendix 1). Akwa Ibom North East is bounded to the north by Ini LGA, to the west by Ikono, Abak, Oruk Anam and Mkpat-Enin LGAs, to the south by Onna, Eket and Esit Eket LGAs, to the south east by Okobo LGA and to the north east by Cross River State.
Uyo being one of the LGAs in the study area is also the state capital and has witnessed increasing influx of migrants into the city, This has also contributed to HIV/AIDS scourge. There are seventeen health facilities providing ART in the Senatorial District.
CHAPTER FOUR
Results and Discussion of Findings
This chapter focused on the analysis of the research data using frequencies and percentages for research questions and Analysis of Variance (ANOVA) for the hypotheses. The results are presented in the under-listed tables.
General Description of the Sample
The demographic data presented in this section include; age, gender, educational level, marital status and religion of the respondents.
CHAPTER FIVE
Summary, Conclusion and Recommendations
Summary
The study was on the psycho-demographic variables and adherence to antiretroviral therapy among people living with HIV and AIDS in Akwa Ibom North East Senatorial District, Nigeria. This study investigated eight variables namely age, gender, marital status, educational status, religion, depression, stigmatization and accessibility of health care. Literature related to the study was extensively reviewed. Eight research questions based on the objectives of the study were formulated and turn into null hypotheses to provide direction for the study All the 17 health facilities rendering care to HIV and AIDS patients were used for this study. The population of the study consisted of 3460 patients that were enrolled for care between January to December 2014. An Ex-post Facto design was used to carry out the study. Stratified random sampling technique was used to select 346 respondents being 10% of the total population of 3460 to participate in the study. A 31 item semi adapted instrument was developed titled Psycho-Demographic Variables and Adherence to Anti Retroviral Therapy Questionnaire (PDVAARTQ) was used in gathering data for the study. All the 346 copies administered were completely filled with the help of the research assistants who were there present. Data obtained from the questionnaires were coded and analyzed using frequencies and Percentages for research questions, and One-way Analysis of Variance tested at .05 level of significance. All the hypotheses were tested at .05 level of significance. The following findings were observed.
- There was a significant influence of age on adherence to ART among the PLWHA.
- Gender did not have any significant influence on adherence to ART among PLWHA.
- Marital status had no significant influence on adherence to ART among PLWHA.
- Educational level had significant influence on adherence to ART among PLWHA.
- Religion has no significant influence on adherence to ART among PLWHA.
- Depression has significant influence on adherence to ART among PLWHA.
- Stigmatization had significant influence on adherence to ART among PLWHA.
- Accessibility of healthcare also had significant influence on adherence to ART among PLWHA.
Conclusion
Based on the findings of this study, it was concluded that there is an established significant influence of age, educational level, depression, stigmatization and accessibility of healthcare services on adherence to antiretroviral therapy among people living with HIV and AIDS in Akwa Ibom North East Senatorial District. There was no significant influence of gender, marital status and religion on adherence to ART among PLWHA. Therefore if measures are instituted to check these influencing factors of adherence then optimal level of adherence to ART will be achieved for effective reduction of HIV and AIDS related mortality. In view of the serious implications of non-adherence for public health, there is a critical need for targeted intervention strategies that will increase the level of adherence.
Recommendations
Based on the findings and conclusions, the following recommendations are made:
- Health education should be intensified in the treatment centres and to all and sundry on the importance of adherence to antiretroviral therapy which is the only way to prolong life as there is no known cure to HIV infections. This health education should also encompass drug side effects and how to deal with them, in order for patients to avoid taking the drugs. This may help improve adherence and compliance. Health workers should consider educational level of each patient and give adequate health information for easy understanding.
- HIV positive patients should be involved in developing strategies to improve compliance to the treatment regimen. This calls for an urgent need to develop adherence intervention tailored to specific needs of the patients.
- Policy makers must work towards policies that will eliminate barriers to accessing care but encourage patients to achieve optimal adherence levels.
- Health workers should try to improve their relationship with clients as this will help to identify problems in the course of rendering care to those on treatment.
- Social support and networking should be instituted. The PLWHAs should be encouraged to participate effectively in support groups. This will reduce the public attitude stigma experienced by them in the long run. Also stigma coping strategies should be developed.
- The government, NGOs and other health workers should periodically assess patients level of depression so as to ameliorate any impediment to adherence. Counselling should be made an integral part of treatment.
- Encourage patient on family disclosure.
Limitation of the Study
The study does have some limitations.
- Adherence was assessed through a self-reporting adherence questionnaire and not other more objective tools such as electronic pill caps, pill counts and biological method like patient’s viral load and CD4+ count. Therefore results could be susceptible to socially desirable reporting.
- In this study adherent information was collected by the clinical staff. They were used as research assistants, since the researcher was not familiar to the patients.
- It may also be possible that selection bias occurred as only those PLWHA who were at the clinic at the time of data collection were included and those who collect their medication by proxy from the clinic could not be assessed thus they were excluded from the study.
Ethical Consideration
Since this study involved people living with HIV and AIDS that are enrolled for treatment, certain considerations were taken in order to ensure ethical standards in this research. They included protection of the right of the participants and the institutions, maintenance of scientific integrity of the research and dissemination of research findings.
The purpose and benefits of the study were explained to the respondents by the researcher before the medical personnel at each of the treatment centres. Then the respondents were allowed to voluntarily accept to participate in the study.
The respondents were assured that all the responses and information obtained from them will not be disclosed to anyone. The questionnaires were free from personal identifiers like addresses or names to avoid any unfair treatment. Data obtained were coded with numbers.
All respondents were briefed about the study objectives, rights, benefits and potential risks. All forms of force or coercion were avoided and no rewards were given to those who accepted to participate in the research. Approvals to carry out the study were obtained from the management of the health facilities where this research was conducted.
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