Uzochukwu B S C, Onwujekwe O E, Onoka A C, Okoli C, Uguru N P, Chukwuogo O I
Department of Community Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria, P.O. Box 3295 Enugu, Nigeria.
Health Policy Plan. 2009 May;24(3):189-96. doi: 10.1093/heapol/czp006. Epub 2009 Mar 10.
The anti-retroviral (ARV) treatment programme in Nigeria is delivered through selected teaching and mission hospitals at a free/subsidized rate. The government aims to scale up ARV treatment in the country. However, non-adherence to ARV medication can lead to viral resistance, treatment failure, toxicities and waste of financial resources. This study examined the factors responsible for non-adherence to free/subsidized ARV treatment in south-east Nigeria. The study was cross-sectional and descriptive. Information was collected from 174 patients selected by simple random sampling from the register of all patients who had been on anti-retroviral therapy (ART) for at least 12 months at the beginning of the study period. Patients were identified during their clinic visits. Information on their socio-demographic profile, ARV treatment and determinants of non-adherence to ARV treatment was obtained from those who gave consent, using pre-tested interviewer-administered questionnaires. All patients clearly understood the need to take ARV drugs throughout their lives, and what the costs entailed. They understood the need for periodic testing, the probability that complications would develop, cost of transportation to treatment site and the daily treatment regimen. Seventy-five per cent of respondents were not adhering fully to their drug regimen; the mean number of days that respondents had been off drugs was 3.57 days the preceding month. Reasons for non-adherence included: physical discomfort (side effects); non-availability of drugs at treatment site; forgetting to carry drugs during the day; fear of social rejection; treatment being a reminder of HIV status; and selling of own drugs to those unable to enrol in the projects. Being female, under 35 years, single, and having higher educational status were significantly associated with non-adherence. It is important that policy makers and programme managers address the factors responsible for non-adherence when scaling up subsidized ARV treatment in Nigeria and other parts of sub-Saharan Africa.
尼日利亚的抗逆转录病毒（ARV）治疗项目通过选定的教学医院和教会医院以免费/补贴的方式提供。政府旨在扩大该国的抗逆转录病毒治疗规模。然而，不坚持服用抗逆转录病毒药物会导致病毒耐药性、治疗失败、毒性反应以及财政资源的浪费。本研究调查了尼日利亚东南部不坚持免费/补贴抗逆转录病毒治疗的相关因素。该研究为横断面描述性研究。从研究期开始时已接受抗逆转录病毒治疗（ART）至少12个月的所有患者登记册中，通过简单随机抽样选取了174名患者收集信息。患者在门诊就诊时被识别出来。使用预先测试的访谈式问卷，从同意参与的患者那里获取了他们的社会人口学特征、抗逆转录病毒治疗情况以及不坚持抗逆转录病毒治疗的决定因素等信息。所有患者都清楚地了解终身服用抗逆转录病毒药物的必要性以及所需费用。他们明白定期检测的必要性、出现并发症的可能性、前往治疗地点的交通费用以及每日治疗方案。75%的受访者未完全坚持药物治疗方案；受访者上个月停药的平均天数为3.57天。不坚持治疗的原因包括：身体不适（副作用）；治疗地点药物供应不足；白天忘记带药；害怕被社会排斥；治疗会让人想起自己的艾滋病毒感染状况；以及将自己的药物卖给无法加入该项目的人。女性、35岁以下、单身以及较高的教育程度与不坚持治疗显著相关。在尼日利亚和撒哈拉以南非洲其他地区扩大补贴抗逆转录病毒治疗规模时，政策制定者和项目管理者解决导致不坚持治疗的因素非常重要。
