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Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon

Received: 11 November 2024     Accepted: 22 November 2024     Published: 9 December 2024
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Abstract

The success of antiretroviral treatment (ART) depends on adherence. Adherence is necessary to reduce the risk of resistance, restore immunity, and reduce incidence, morbidity and mortality. Data on the ratio of refugees and conflict-affected people living with HIV and on ART needs are scarce. The objective of this study is to identify barriers to ART adherence among refugees living with HIV/AIDS in Douala. In a cross-sectional, analytical study conducted among refugees living with HIV/AIDS in Douala and followed in health facilities that are partners of the High Commissioner for Refugees (HCR). Adherence was evaluated on the basis of patient declarations (declared adherence) and the regularity of the renewal of their prescriptions (calculated adherence). The quantitative data collected with the anonymous questionnaire administered after informed consent was entered with Epi Info version 7.1.3.0. Descriptive and inferential analysis was carried out with SPSS version 17.0, which allowed us to determine the association between predisposing factors and adherence to antiretroviral treatment using Pearson's Chi-square test. 200 refugees meeting our inclusion criteria were interviewed. The average length of follow-up was 4 years. The average age was 40.66 ± 9.35 years and the sex ratio was 2.39 in favour of the female sex. 91.5% of the refugees had started treatment more than a year ago. The level of reported compliance was significantly lower than the overall level of calculated compliance (67.5% vs. 71.0%, P=0.000). The main obstacles to adherence were forgetting and lack of food. People who received accurate information about their illness were more observant (P=0.000). Adherence to antiretroviral treatment was best when the year of initiation of treatment was two years or more (P=0.000) and the patient knew the duration of treatment (p=0.000). The low adherence rate (<95%) among refugees was related to several factors. The difference observed between the results of the two methods used to estimate adherence shows us the need for biological methods in assessing the level of treatment adherence. Measures will be needed to improve the level of adherence among refugees, including the strengthening of psycho-social support.

Published in International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 10, Issue 2)
DOI 10.11648/j.ijhpebs.20241002.11
Page(s) 45-56
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Adherence to Treatment, Refugees, Antiretroviral Treatment, HIV/AIDS

References
[1] Tourette-Turgis C, Rébillon M. " An intervention model of therapeutic adherence: MOTHIV ". In: Tourette-Turgis C, Rébillon M., Implementing HIV/AIDS Treatment Adherence Counselling - From Theory to Practice. Parish, 2022, pp. 99-122.
[2] Ume Abbas. Antiretroviral Therapy and Pre-exposure Prophylaxis: Combined Impact on HIV Transmission and Drug Resistance in South Africa. J Infect Dis. 2013; 208(2): 224-234.
[3] World health organization (WHO). "Adherence to long-term therapies. Evidence for action," 2003. Available at
[4] Badré-Sentenac S. Using the renewal of antiretroviral prescriptions as an indicator of adherence in Yaoundé. J Pharm Clin. 2015; 24(4):225-31.
[5] UNHCR, Global Trends in 2008: Refugees, Asylum Seekers, Returnees, Internally Displaced and Stateless Persons, Geneva, 2009.
[6] UNHCR multi-year and multi-partner strategy 2018-2020 english.pdf. Available at:
[7] National Committee for the Fight against HIV and AIDS. Annual Report 2018 of activities to fight HIV AND AIDS and STIs in Cameroon. Yaoundé: CNLS; March 2024.
[8] Joint United Nations Program on HIV/AIDS. 90-90-90. An ambitious treatment target to help end the AIDS epidemic. Geneva, Switzerland: UNAIDS; 2014, p. 12.
[9] Mbopi-Kéou F-X. A study of factors related to adherence to antiretroviral treatment among patients monitored at the HIV/AIDS Care Unit of the District Hospital of Dschang, Cameroon. The Pan African Medical Journal. 2012; 12: 55.
[10] Costagliola D. How to measure compliance? In: HIV/AIDS treatment adherence- Measurement, determinants, evolution. Parish, National Agence of Researches on HIV, Social Sciences Collection and HIV/AIDS, 2021: 33-42.
[11] Vanhove GF. Patient compliance and drug failure in protease inhibitor monotherapy. JAMA. 2006; 276(24): 1955-6.
[12] Emmanuel Noel Essomba. Factors associated with non-adherence to treatment of HIV- infected adults on antiretroviral drugs in a referral hospital in Douala, Cameroon. The Pan African Medical Journal. 2015. PubMed | Google Scholar.
[13] Camerounlink.com. Cameroun link actualities : Cameroon- Fight against AIDS: Mama Fouda's new prescriptions. Yaoundé; 2016, available at:
[14] Joint United Nations Programs on HIV/AIDS (UNAIDS). UNAIDS report on the global AIDS epidemic. New York: UNAIDS; 2012.
[15] Mouala, C., P. Roux, M. Okome, S. Sentenac, F. Okome, U. Nziengui, F. Olivier, K. Benjaber and J. L. Rey (2016). "[Assessment of compliance with ARV treatment in Africa]."Med Trop (Mars) 66(6): 610-614.
[16] Oumar, A., S. Dao, A. Diamoutene, S. Coulibaly, B. Koumare, Maiga, II and E. Mariko (2017). "[Factors associated with antiretroviral treatment observance at Point "G" hospital]." Mali Med 22(1): 18-21.
[17] Nziengui, U., C. Zamba and J. L. Rey (2016). "[Difficulties of the patients to undergo their ART at the Libreville outpatient health center, Gabon]." Bull Soc Pathol Exot 99(1): 23-27.
[18] Antignac M, G. S., Golmard J-L, Junot H, Fievet M.-H, Thuillier A. (2023). "Evaluation of the factors influencing adherence to drug treatments in HIV-infected patients". Journal of Clinical Pharmacy 22(2): 78-87.
[19] Folefack Tengomo G. Determinants of non-adherence to antiretroviral therapy by adult patients infected with HIV and followed up at Cotonou University Hospital. IRSP. 2003; 4(8): 112- 146.
[20] Spire B. Adherence to highly active antiretroviral therapies (HAART) in HIV-infected patients: from a predictive to a dynamic approach. Soc Sci Med. 2002; 54(10): 1481-96.
[21] Ahmed, A., C. Katlama, J. Ghosn, M. Guiguet and D. Costagliola (2007). "[Evaluation of compliance with antiretroviral treatment in a cohort of 200 patients in Djibouti, 2005]." East Mediter Health J 13(6): 1286-1297.
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  • APA Style

    Bruno, E. S., Rodrigue, Y., Robert, T. T., Nsongmayi, E. D., Isabelle, L., et al. (2024). Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 10(2), 45-56. https://doi.org/10.11648/j.ijhpebs.20241002.11

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    ACS Style

    Bruno, E. S.; Rodrigue, Y.; Robert, T. T.; Nsongmayi, E. D.; Isabelle, L., et al. Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2024, 10(2), 45-56. doi: 10.11648/j.ijhpebs.20241002.11

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    AMA Style

    Bruno ES, Rodrigue Y, Robert TT, Nsongmayi ED, Isabelle L, et al. Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon. Int J HIV/AIDS Prev Educ Behav Sci. 2024;10(2):45-56. doi: 10.11648/j.ijhpebs.20241002.11

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  • @article{10.11648/j.ijhpebs.20241002.11,
      author = {Ebong Serge Bruno and Yemene Rodrigue and Tefe Tagne Robert and Ekwi Damian Nsongmayi and Lendem Isabelle and Mballa Amougou Jean Claude and Nke Martine and Edima Hélène Carole and Mbebi Enone Juste Patient and Bika Claude and Adiogo Dieudonné and Eboumbou Else Carole},
      title = {Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon
    },
      journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
      volume = {10},
      number = {2},
      pages = {45-56},
      doi = {10.11648/j.ijhpebs.20241002.11},
      url = {https://doi.org/10.11648/j.ijhpebs.20241002.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20241002.11},
      abstract = {The success of antiretroviral treatment (ART) depends on adherence. Adherence is necessary to reduce the risk of resistance, restore immunity, and reduce incidence, morbidity and mortality. Data on the ratio of refugees and conflict-affected people living with HIV and on ART needs are scarce. The objective of this study is to identify barriers to ART adherence among refugees living with HIV/AIDS in Douala. In a cross-sectional, analytical study conducted among refugees living with HIV/AIDS in Douala and followed in health facilities that are partners of the High Commissioner for Refugees (HCR). Adherence was evaluated on the basis of patient declarations (declared adherence) and the regularity of the renewal of their prescriptions (calculated adherence). The quantitative data collected with the anonymous questionnaire administered after informed consent was entered with Epi Info version 7.1.3.0. Descriptive and inferential analysis was carried out with SPSS version 17.0, which allowed us to determine the association between predisposing factors and adherence to antiretroviral treatment using Pearson's Chi-square test. 200 refugees meeting our inclusion criteria were interviewed. The average length of follow-up was 4 years. The average age was 40.66 ± 9.35 years and the sex ratio was 2.39 in favour of the female sex. 91.5% of the refugees had started treatment more than a year ago. The level of reported compliance was significantly lower than the overall level of calculated compliance (67.5% vs. 71.0%, P=0.000). The main obstacles to adherence were forgetting and lack of food. People who received accurate information about their illness were more observant (P=0.000). Adherence to antiretroviral treatment was best when the year of initiation of treatment was two years or more (P=0.000) and the patient knew the duration of treatment (p=0.000). The low adherence rate (<95%) among refugees was related to several factors. The difference observed between the results of the two methods used to estimate adherence shows us the need for biological methods in assessing the level of treatment adherence. Measures will be needed to improve the level of adherence among refugees, including the strengthening of psycho-social support.
    },
     year = {2024}
    }
    

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    T1  - Barriers to Antiretroviral Treatment Adherence Among Refugees Living with HIV/AIDS in Douala, Cameroon
    
    AU  - Ebong Serge Bruno
    AU  - Yemene Rodrigue
    AU  - Tefe Tagne Robert
    AU  - Ekwi Damian Nsongmayi
    AU  - Lendem Isabelle
    AU  - Mballa Amougou Jean Claude
    AU  - Nke Martine
    AU  - Edima Hélène Carole
    AU  - Mbebi Enone Juste Patient
    AU  - Bika Claude
    AU  - Adiogo Dieudonné
    AU  - Eboumbou Else Carole
    Y1  - 2024/12/09
    PY  - 2024
    N1  - https://doi.org/10.11648/j.ijhpebs.20241002.11
    DO  - 10.11648/j.ijhpebs.20241002.11
    T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
    JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
    JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
    SP  - 45
    EP  - 56
    PB  - Science Publishing Group
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    AB  - The success of antiretroviral treatment (ART) depends on adherence. Adherence is necessary to reduce the risk of resistance, restore immunity, and reduce incidence, morbidity and mortality. Data on the ratio of refugees and conflict-affected people living with HIV and on ART needs are scarce. The objective of this study is to identify barriers to ART adherence among refugees living with HIV/AIDS in Douala. In a cross-sectional, analytical study conducted among refugees living with HIV/AIDS in Douala and followed in health facilities that are partners of the High Commissioner for Refugees (HCR). Adherence was evaluated on the basis of patient declarations (declared adherence) and the regularity of the renewal of their prescriptions (calculated adherence). The quantitative data collected with the anonymous questionnaire administered after informed consent was entered with Epi Info version 7.1.3.0. Descriptive and inferential analysis was carried out with SPSS version 17.0, which allowed us to determine the association between predisposing factors and adherence to antiretroviral treatment using Pearson's Chi-square test. 200 refugees meeting our inclusion criteria were interviewed. The average length of follow-up was 4 years. The average age was 40.66 ± 9.35 years and the sex ratio was 2.39 in favour of the female sex. 91.5% of the refugees had started treatment more than a year ago. The level of reported compliance was significantly lower than the overall level of calculated compliance (67.5% vs. 71.0%, P=0.000). The main obstacles to adherence were forgetting and lack of food. People who received accurate information about their illness were more observant (P=0.000). Adherence to antiretroviral treatment was best when the year of initiation of treatment was two years or more (P=0.000) and the patient knew the duration of treatment (p=0.000). The low adherence rate (<95%) among refugees was related to several factors. The difference observed between the results of the two methods used to estimate adherence shows us the need for biological methods in assessing the level of treatment adherence. Measures will be needed to improve the level of adherence among refugees, including the strengthening of psycho-social support.
    
    VL  - 10
    IS  - 2
    ER  - 

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Author Information
  • Unit of Physiology and Medicine of Physical and Sports Activities, University of Douala, Douala, Cameroon;Department of Public health, Institute of Health Applied Sciences, Douala, Cameroon;Department of Biomedical and Medical Sciences, University of Ebolowa, Ebolowa, Cameroon

  • Department of Public health, Institute of Health Applied Sciences, Douala, Cameroon

  • Department of Sociology, University of Douala, Douala, Cameroon

  • Department of Biomedical and Medical Sciences, University of Ebolowa, Ebolowa, Cameroon

  • Department of Biomedical and Medical Sciences, University of Ebolowa, Ebolowa, Cameroon

  • Department of Biomedical and Medical Sciences, University of Ebolowa, Ebolowa, Cameroon;Department of Sociology, University of Douala, Douala, Cameroon

  • Department of Biomedical and Medical Sciences, University of Ebolowa, Ebolowa, Cameroon

  • Department of Biomedical and Medical Sciences, University of Ebolowa, Ebolowa, Cameroon

  • Unit of Physiology and Medicine of Physical and Sports Activities, University of Douala, Douala, Cameroon

  • Unit of Physiology and Medicine of Physical and Sports Activities, University of Douala, Douala, Cameroon

  • Department of Biological Sciences, University of Douala, Douala, Cameroon

  • Department of Biological Sciences, University of Douala, Douala, Cameroon

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