Perceived barriers and facilitators to adherence to antiretroviral therapy among persons living with HIV in the Upper East Region Dr. Gifty Apiung Aninanya, Mr. Cosmos Ohene-Adjei, Dr. Ayisi Addo, Mr. Twumasi Opoku Samuel, Dr. Mokowa Blay Adu-Gyamfi

Outline Introduction Objectives Methodology Results Discussion Acknowledgement

INTRODUCTION I Due to ARTs, HIV is becoming a treatable chronic condition (Deeks et al 2013 & Dorfman & Saag 2014) Rapid scale up of ART in Ghana has resulted in an increased focus on patient adherence Non-adherence may result in regimen failure, immune suppression and higher treatment costs (Bangsberg et al 2004, Stevens et al 2004) However, ART promote effective viral suppression, reduces the risk of transmission and prevents death [Mills eta al 2011&WHO 2013] To ensure positive treatment outcomes, high levels of ART adherence are necessary(Harden et al 2007 & Bangsberg 2006)

INTRODUCTION II However, little evidence exists on barriers and facilitators to ART adherence among PLHIV in Ghana This qualitative study examined barriers and facilitators to ART adherence among PLHIV

Study Objectives To explore barriers to ARV adherence among PLHIV in the Upper East Region of Ghana To examine facilitators to ARV adherence among PLHIV in the Upper East Region of Ghana To identify strategies to adopt to improve PLHIV adherence to ARVs in the Upper East Region

METHODOLOGY I Study setting It was conducted in six facilities Study population and sampling 53 participants A purposive sampling technique Eligibility to participate -aged 18 years & on ARVs

METHODOLOGY II Data Collection Five FGDs & 10 IDIs with PLHIV 12 IDIs with health staff Data quality was ensured through training of data collectors IDIs covered participants lived experiences on enablers and barriers to ART adherence Data Analysis Interviews were coded and transcribed Thematic analysis Identified major themes

RESULTS-BARRIERS TO ADHERENCE I Lack of nutritional support Side effects of ART Improvement in health Inadequate social support Lack of health insurance Stigma & discrimination Access to transportation Economic problems Negative attitudes of some health staff

RESULTS –BARRIERS TO ART ADHERENCE II “Ever since World Food Program stopped supporting us with food items, some PLHIV have not been able to feed themselves. Some of them are even lost to follow-up due of the unavailability of food” (FGD Female Participant ) “I had nightmares, nausea, rashes and itches when I started taking the ARVs. I nearly stopped taking the drugs”(IDI, Female Participant) “The big size of the ART makes it difficult for me to take it regularly”(IDI Male participant) “Most PLHIV visited HIV clinics where no one would know them for treatment”(Male Pharmacist)

RESULTS- FACILITATORS TO ADHERENCE I Appropriate counseling and education, positive attitude of health staff Provision of nutritional support, Improved health status due to ART The use of reminder aids Pregnancy Stigma-reduction policies “When PLHIV got nutritional support from WFP, adherence to treatment was perfect” (Female Health Worker) “Counselors are lovely and they don’t discriminate against. I receive my drugs regularly”(IDI Female Participant)

RESULTS- FACILITATORS TO ADHERENCE II “Counseling and linking clients to Models of Hope enabled them to take their medications with ease”( FGD Female Participant) “I set a reminder on my mobile phone to remind me of the time of the time to take ARVs” (Female IDI participant) “I am now healthy because of the ARVs. I was bedridden, but now I am very healthy and can do hard work” (Female IDI Participant)

RESULTS- STRATEGIES TO IMPROVE ADHERENCE I Sensitize the community on adherence Stigma-reduction strategies Empower CHPS centres to pick medicines for PLHIV in their respective zones Nutritional support Provide income-generating activities Patient-provider interaction should be encouraged Home visits and soliciting for family support Financial support to MOH

RESULTS- STRATEGIES TO IMPROVE ADHERENCE II Alternative way of treatment in the form of injections and syrup “Taking ARVs on daily basis is monotonous. The big size of the drug makes me uncomfortable when I swallow it. If they could make it in the form of syrup or injection, it would have been easier to take it ( Female IDI Participant)

DISCUSSION AND CONCLUSION Several barriers affect adherence to ART Similar barriers reported elsewhere(Mukherjee et al., 2006 & Bangsberg , Howland et al., 2000; Ware, & Simoni, 2006; Wasti et al 2012) It is recommended that: Nutritional support Provision of income generating activities Enrolling clients onto the NHIS Supporting MOH Medication-related issues Ghana will achieve its aim of having zero AIDS-related deaths

ACKNOWLEDGEMENT All participants who participated in the study Ghana Health Service NACP NAP+ Ghana