Annals of African Medicine

: 2015  |  Volume : 14  |  Issue : 3  |  Page : 159--160

Barriers to HIV treatment adherence: Perspectives from the nonadherent at a treatment center in South-South, Nigeria

Omosivie Maduka, Charles I Tobin-West 
 Department of Preventive and Social Medicine, University of Port Harcourt, Port Harcourt, Nigeria

Correspondence Address:
Omosivie Maduka
Department of Preventive and Social Medicine, University of Port Harcourt, P.M.B. 5323, Port Harcourt

How to cite this article:
Maduka O, Tobin-West CI. Barriers to HIV treatment adherence: Perspectives from the nonadherent at a treatment center in South-South, Nigeria.Ann Afr Med 2015;14:159-160

How to cite this URL:
Maduka O, Tobin-West CI. Barriers to HIV treatment adherence: Perspectives from the nonadherent at a treatment center in South-South, Nigeria. Ann Afr Med [serial online] 2015 [cited 2021 Aug 1 ];14:159-160
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The aim of highly active antiretroviral treatment (HAART) is to achieve a reduction in the viral load of patients and allow for immune reconstitution and clinical improvement. [1] However, adherence to HAART constitutes a challenge for many people living with HIV in Nigeria. Previous studies carried out in the study area reported low adherence rates. [2],[3]

We held four focus group discussions (FGDs) with 27 purposively selected people living with HIV (14 females and 13 males) who had been on HAART for at least 3 months prior to the study and whose self-reported adherence to HAART was below 95% in the month preceding the study. [4] The FGDs explored their perspectives of barriers to adherence.

Three major themes emerged after thematic content analysis. These are patient-based, treatment-based and provider-based barriers to adherence. Barriers relating to patient behavior and relationships identified included nondisclosure of HIV status, sharing of drugs among couples, alcohol use and financial constraints. In the words of one participant "I didn't tell my wife for 6 years now… because if she hears it, it will scatter my marriage" (PLHIV, 40 years, male, married). Another participant stated "I used to give my husband my drugs when his own finishes… to help him…" (PLHIV, 36 years, female, married). Another stated "I often said to myself, let me drink and forget my problems."(PLHIV, 47 years, male, single). And yet another said "… they like sending somebody for test especially this CD4 of a thing. Somebody does not have money to eat…where will the N1000 come from…" (PLHIV, 48 years, female, married).

Treatment related barriers identified included poor understanding about the effects of the drugs, forgetfulness and side effects. Statements in this regard include "… I want to be pregnant, so I have to stop it" (PLHIV, 33 years, female, married). "Doctor, when I started taking this medicine newly, I thought I was going to die… It was terrible." (PLHIV, 32, female, married).

Barriers associated with treatment providers included long clinic hours and poor attitude of health workers. A discussant stated "When I remember what I will pass through here, the problem I will get to come for my drugs, I'll rather stay and manage the little ones that I have…" (PLHIV, 54 years, male, married).

Patients on HAART should benefit from adherence counseling and training. This will build their capacity to use reminder systems such as alarms for dosing time and clinic appointments, to always carry their drugs with them and to take clinic appointments seriously. Text message reminders are also useful to remind patients of appointments and reinforce adherence. [5] Establishing and sustaining vibrant support groups and actively engaging treatment supporters for each patient enrolled into care is also recommended. In addition, better organization of treatment centers, adequate staffing and periodic staff trainings is advocated. Decentralization of HIV treatment centers to secondary and primary health facilities should be considered.


1WHO, editor. Treating 3 Million by 2005: Making it Happen: The WHO Strategy: The WHO and UNAIDS Global Initiative to Provide Antiretroviral Therapy to 3 Million People with HIV/AIDS in Developing Countries by the End of 2005. Geneva: WHO; 2004.
2Nwauche CA, Erhabor O, Ejele OA, Akani CI. Adherence to antiretroviral therapy among HIV-infected subjects in a resource-limited setting in the Niger Delta of Nigeria. Afr J Health Sci 2006;13:13-7.
3Asekomeh EG, Ebong OO, Onwuchekwa AC. Effects of psychosocial parameters on adherence of adult Nigerians to antiretroviral therapy. Niger J Psychiatry 2010;8:26-32.
4Federal Ministry of Health. National Guidelines for HIV and AIDS Treatment and Care in Adolescents and Adults. Abuja Nigeria: Federal Ministry of Health; 2007.
5Maduka O, Tobin-West CI. Adherence counseling and reminder text messages improve uptake of antiretroviral therapy in a tertiary hospital in Nigeria. Niger J Clin Pract 2013;16:302-8.