Self-reported adherence to HIV/AIDS management and associated factors among gender-groups at a referral treatment centre in Port Harcourt, Nigeria


  • Anwuri Luke Department of Community Medicine, College of Medical Sciences, Rivers State Ministry of Health, Port Harcourt, Rivers State, Nigeria
  • Golden Owhonda Department of Public Health and Disease Control, Rivers State Ministry of Health, Port Harcourt, Rivers State, Nigeria
  • Charles Tobin-West Department of Preventive and Social Medicine, University of Port Harcourt, Choba, Rivers State, Nigeria



Self-reported adherence, HIV/AIDS management, Associated factors, Gender-groups, Referral treatment centre


The self-reported method of assessing adherence levels among human immuno-deficiency virus (HIV)-positive patients is the most commonly applied measure, despite its limitations with recall bias and overestimation of outcome variables. This study determined the levels of self-reported adherence to HIV/AIDS management and its associated factors among gender groups at a referral treatment centre in Port Harcourt, Nigeria. This cross-sectional study was conducted among HIV-positive adults attending the University of Port Harcourt Teaching Hospital between September 2020 to November 2020. Systematic sampling technique was employed to select eligible participants using a 7-item brief medication self-reporting tool. Data was analysed with statistical package for social science (SPSS) version-25. Test of association was measured using Pearson’s Chi-square and spearman rho rank tests, set at a significance level of p<0.05 and 95% confidence interval. Confounding variables were controlled using multiple logistic regression analysis. 1600 participants; females (800), and males (800) were recruited. The mean age and standard deviation reported were; male (44.53±10.50), female (40.58±9.34). The mean self-reported optimal adherence levels observed were; male (98.7±6.4) and female (97.3±10.0). The significant variables associated with self-reported adherence levels were revealed only among the male group; religion (aOR=0.076; 95% CI=0.024-0.239; p<0.001), level of education (aOR=0.451; 95% CI=0.213-0.955; p=0.038), and non-payment for HIV support services (aOR=4.105; 95% CI; 1.712-9.792; p<0.001). The male group self-reported better optimal adherence than the female group. Also, the associated factors to self-reported adherence were only significant among the male group. Therefore, robust adherence counselling should be targeted at improving adherence among the female gender.

Author Biography

Anwuri Luke, Department of Community Medicine, College of Medical Sciences, Rivers State Ministry of Health, Port Harcourt, Rivers State, Nigeria

Department of Community Medicine


Consultant Public Health Physician


Nomoto R. Gender equality: Glossary of Terms and Concepts. UNICEF Regional Office for South Asia Nepal, India. 2017;17. Available at: Accessed on 25 December 2020.

Klaas NE, Thupayagale-Tshweneagae G, Makua TP. The Role of Gender in the Spread of HIV and AIDS among Farmworkers in South Africa. Afr J Prim Health Care Fam Med. 2018;10(1):8.

Sia D, Onadja Y, Hajizadeh M, Heymann SJ, Brewer TF, Nandi A. What Explains Gender Inequalities in HIV/AIDS Prevalence in Sub-Saharan Africa? Evidence from the Demographic and Health Surveys. BMC Public Health. 2016;16(1):18.

National Agency for the Control of AIDS (NACA). Guidelines for Gender Mainstreaming in The National HIV/AIDS Response: Training Manual for Capacity Building for Gender Mainstreaming in the National HIV/AIDS Response. Abuja, Nigeria. 2015;181. Available at: › files › pub-pdf › op-guidePDF. Accessed on 25 March 2022.

Leddy AM, Weiss E, Yam E, Pulerwitz J. Gender-Based Violence and Engagement in Biomedical HIV Prevention, Care and Treatment: A Scoping Review. BMC Public Health. 2019;19(897):14.

Haberer JE, Sabin L, Amico KR, Orrell C, Galárraga O, Tsai AC, et al. Improving Antiretroviral Therapy Adherence in Resource‐Limited Settings at Scale: A Discussion of Interventions And Recommendations. J Int AIDS Soc. 2017;20(21371):15.

Abbai NS, Wand H, Ramjee G. Biological Factors That Place Women at Risk for HIV: Evidence from a Large-Scale Clinical Trial in Durban. BMC Womens Health. 2016;16(19):7.

Iacob SA, Iacob DG, Jugulete G. Improving the Adherence to Antiretroviral Therapy, a Difficult but Essential Task for a Successful HIV Treatment: Clinical Points of View and Practical Considerations. Front Pharmacol. 2017;8(831):12.

National AIDS and STIs Control Programme (NASCP). National Guidelines for HIV Prevention Treatment and Care (2016). Abuja, Nigeria: Federal Ministry of Health (FMOH); 2016;250. Available at: Accessed on 23 April 2022.

Joint United Nations Programme on HIV/AIDS (UNAIDS). HIV Care and Support Taking into Account the 2016 WHO Consolidated Guidelines. Geneva, Switzerland; 2016;48. Available at: Accessed on 22 May 2022.

World Health Organization (WHO). Updated Recommendations on Service Delivery for the Treatment and Care of People Living with HIV. Geneva, Switzerland. 2021;79. Available at: Accessed on 12 April 2022.

Umeokonkwo CD, Onoka CA, Agu PA, Ossai EN, Balogun MS, Ogbonnaya LU. Retention in Care and Adherence to HIV and AIDS Treatment in Anambra State Nigeria. BMC Infect Dis. 2019;19(654):11.

Rowell-Cunsolo TL, Hu G. Barriers to Optimal Antiretroviral Therapy Adherence among HIV-Infected Formerly Incarcerated Individuals in New York City. Plos One. 2020;15(6):12.

Kay ES, Batey DS, Mugavero MJ. The HIV Treatment Cascade and Care Continuum: Updates, Goals, and Recommendations for the Future. AIDS Res Ther. 2016;13(35):7.

Enriquez M, Cheng AL, Banderas J, Farnan R, Chertoff K, Hayes D, et al. A Peer-Led HIV Medication Adherence Intervention Targeting Adults Linked to Medical Care but without a Suppressed Viral Load. J Int Assoc Provid AIDS Care JIAPAC. 2015;14(5):441-8.

Been SK, Yildiz E, Nieuwkerk PT, Pogány K, Vijver DAMC van de, Verbon A. Self-Reported Adherence and Pharmacy Refill Adherence are Both Predictive for an Undetectable Viral Load among HIV-Infected Migrants Receiving cART. Plos One. 2017;12(11):12.

Cunningham WE, Nance RM, Golin CE, Flynn P, Knight K, Beckwith CG, et al. Self-Reported Antiretroviral Therapy Adherence and Viral Load in Criminal Justice-Involved Populations. BMC Infect Dis. 2019;19(913):11.

Afe AJ, Motunrayo O, Ogungbade GO. Factors Influencing Adherence to HAART among Patients Living with HIV Infection in Southwest Nigeria: A Cross-Sectional Analysis. J HIV Retro Virus. 2017;4(1):9.

Zhang Q, Li X, Qiao S, Shen Z, Zhou Y. Comparing Self-Reported Medication Adherence Measures with Hair Antiretroviral Concentration among People Living With HIV in Guangxi, China. AIDS Res Ther. 2020;17(1):8.

Nachega JB, Uthman OA, Peltzer K, Richardson LA, Mills EJ, Amekudzi K, et al. Association between Antiretroviral Therapy Adherence and Employment Status: Systematic Review and Meta-Analysis. Bull World Health Organ. 2015;93(1):29-41.

Santos MA, Guimarães MDC, Helena ETS, Basso CR, Vale FC, Carvalho WM do ES, et al. Monitoring Self-Reported Adherence to Antiretroviral Therapy in Public HIV Care Facilities in Brazil. Medicine (Baltimore). 2018;97(1):38-45.

Lam WY, Fresco P. Medication Adherence Measures: An Overview. BioMed Res Int. 2015;217047:12.

Orrell C, Cohen K, Leisegang R, Bangsberg DR, Wood R, Maartens G. Comparison of Six Methods to Estimate Adherence in an ART-Naïve Cohort in a Resource-Poor Setting: Which Best Predicts Virologic and Resistance Outcomes? AIDS Res Ther. 2017;14(20):11.

Da W, Li X, Qiao S, Zhou Y, Shen Z. Evaluation of Self-Report Adherence Measures and their Associations with Detectable Viral Load among People Living with HIV (PLHIV) in China. PLoS One. 2018;13(8):13.

Oku AO, Owoaje ET, Oku OO, Monjok E. Prevalence and Determinants of Adherence to Highly Active Anti- Retroviral Therapy amongst People Living with HIV/AIDS in a Rural Setting in South-South Nigeria. Afr J Reprod Health. 2014;18(1):133-44.

Afolabi B, Afolabi M, Afolabi A, Odewale M, Olowookere SA. Roles of family Dynamics on Adherence to Highly Active Antiretroviral Therapy among People Living with HIV/AIDS at a Tertiary Hospital in Osogbo, South-West Nigeria. Afr Health Sci. 2013;13(4): 920-6.

Yaya I, Landoh DE, Saka B, Patchali PM, Wasswa P, Aboubakari AS, et al. Predictors of Adherence to Antiretroviral Therapy among People Living with HIV and AIDS at the Regional Hospital of Sokodé, Togo. BMC Public Health. 2014;14(1308):10.

Bonolo P, Ceccato M, Rocha G, Acurcio F, Campos L, Guimaraes M. Gender Differences in Non-Adherence among Brazilian Patients Initiating Antiretroviral Therapy. Clinics. 2013;68(5):612-20.

Heestermans T, Browne JL, Aitken SC, Vervoort SC, Klipstein-Grobusch K. Determinants of Adherence to Antiretroviral Therapy among HIV-Positive Adults in sub-Saharan Africa: A Systematic Review. BMJ Glob Health. 2016;1(4):13.

Kahamba JS, Massawe FA, Nombo CI. How Gender Affects Adherence to Antiretroviral Therapy. Tanzania; 2017: 35. Available at: publications /wp-17-196. Accessed on 30 January 2020.

Eyassu MA, Mothiba TM, Mbambo-Kekana NP. Adherence to Antiretroviral Therapy among HIV and AIDS Patients at the Kwa-Thema Clinic in Gauteng Province, South Africa. Afr J Prim Health Care Fam Med. 2016;8(2):7.

Chineke HN, Adogu POU, Uwakwe KA, Ewuzie MU. Assessment of Level of Adherence to Antiretroviral Therapy among Human Immune Deficiency Virus/Acquired Immune Deficiency Syndrome Patients at Imo State University Teaching Hospital, Orlu, Nigeria. Niger J Gen Pract. 2015;3(1):21-5.

Boullé C, Kouanfack C, Laborde-Balen G, Boyer S, Aghokeng AF, Carrieri MP, et al. Gender Differences in Adherence and Response to Antiretroviral Treatment in the Stratall Trial in Rural District Hospitals in Cameroon. JAIDS J Acquir Immune Defic Syndr. 2015;69(3):355-64.

Ayuk A, Udonwa N, Gyuse A. Influence of Spirituality and Religion on Adherence to Highly Active Antiretroviral Therapy in Adult HIV/AIDS Patients in Calabar, Nigeria. Recent Adv Biol Med. 2017;3(2017):48-57.

Mabunda K, Ngasama E, Babalola J, Zunza M, Nyasulu P. Determinants of Adherence to Antiretroviral Treatment among Human Immunodeficiency Virus-Infected Young Adults Attending Care at Letaba Hospital HIV Clinic, Limpopo Province, South Africa. Pan Afr Med J. 2019;32(37):14.

Semvua SK, Orrell, C, Mmbaga, BT, Semvua HH, Bartlett, JA, Boulle AA. Predictors of Non-Adherence to Antiretroviral Therapy among HIV Infected Patients in Northern Tanzania. Plos One. 2017;12(12):17.

Puskas CM, Kaida A, Miller CL, Zhang W, Yip B, Pick N, et al. The Adherence Gap: A Longitudinal Examination of Men’s and Women’s Antiretroviral Therapy Adherence in British Columbia, 2000-2014. AIDS. 2017;31(6):827-33.

Beer L, Mattson CL, Bradley H, Skarbinski J. Understanding Cross-Sectional Racial, Ethnic, and Gender Disparities in Antiretroviral Use and Viral Suppression among HIV Patients in the United States. Medicine (Baltimore). 2016;95(13):9.

Robinson AC, Knowlton AR. Gender Differences in Psychosocial Factors Associated with HIV Viral Suppression among African-American Injection Drug Users. AIDS Behav. 2016;20(2):385-94.

Sonko I, Chung MH, Hou WH, Chen WT, Chang PC. Predictors of HIV Testing Among Youth Aged 15–24 Years in the Gambia. Plos One. 2022;17(2):17.

McKinney O, Modeste NN, Lee JW, Gleason PC, Maynard-Tucker G. Determinants of Antiretroviral Therapy Adherence among Women in Southern Malawi: Healthcare Providers’ Perspectives. AIDS Res Treat. 2014;489370:10.

Musumari P, Wouters E, Kayembe P, Kiumbu NM, Mbikayi S. Food Insecurity is Associated with Increased Risk of Non-Adherence to Antiretroviral Therapy among HIV-Infected Adults in the Democratic Republic of Congo: A Cross-Sectional Study. Plos One. 2014;9(1):10.

Usman SA, Shehu A, Ajumobi O, Gidado S, Dalhatu I, Balogun M, et al. Predictors of Non-Adherence to Antiretroviral Therapy among HIV Patients in Secondary Health Care Facilities in Kano State- Nigeria: A Case-Control Study. Pan Afr Med J. 2019;32(1):4.

Okoronkwo I, Okeke U, Chinweuba A, Iheanacho P. Nonadherence Factors and Sociodemographic Characteristics of HIV-Infected Adults Receiving Antiretroviral Therapy in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. ISRN AIDS. 2013;843794:8.

Ayele G, Tessema B, Amsalu A, Ferede G, Yismaw G. Prevalence and associated factors of treatment failure among HIV/AIDS patients on HAART attending University of Gondar Referral Hospital Northwest Ethiopia. BMC Immunol. 2018;19(37):13.

Hansana V, Sanchaisuriya P, Durham J, Sychareun V, Chaleunvong K, Boonyaleepun S, et al. Adherence to Antiretroviral Therapy (ART) among People Living with HIV (PLHIV): A Cross-Sectional Survey to Measure in Lao PDR. BMC Public Health. 2013;13(617):11.

Okunola OA, Muoghalu CO, Irinoye AI. Socio-Cultural Factors Influencing Adherence to Antiretroviral Therapy among People Living with HIV/AIDS in Obafemi Awolowo University Teaching Hospitals, Ile-Ife, Nigeria. ARC J AIDS. 2018;3(1):1-14.

Maduka O, Tobin-West C. Adherence Counseling and Reminder Text Messages Improve Uptake of Antiretroviral Therapy in a Tertiary Hospital in Nigeria. Niger J Clin Pract. 2013;16(3):302-8.

Negesa L. Adherence to Antiretroviral Therapy and Factors affecting People Living with HIV/AIDS and Taking Antiretroviral Therapy, Dire Dawa Town, Eastern Ethiopia. J Infect Dis Treat. 2017;3(1):6.




How to Cite

Luke, A., Owhonda, G., & Tobin-West, C. (2022). Self-reported adherence to HIV/AIDS management and associated factors among gender-groups at a referral treatment centre in Port Harcourt, Nigeria. International Journal Of Community Medicine And Public Health, 9(10), 3878–3888.



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