Prevalence and Factors Associated with HIV Treatment Non-adherence Among People Living with HIV in Three Regions of Cameroon: A Cross-sectional Study

Background: In Cameroon, HIV care decentralization is enforced as a national policy, but follow-up of people living with HIV (PLWH) is provider-driven, with little patient education and limited patient participation in clinical surveillance. These types of services can result in low antiretroviral therapy (ART) adherence. The objective of this study was to assess the prevalence and predictors of ART non-adherence among PLWH in Cameroon.

Methods: A cross-sectional descriptive study of PLWH in HIV treatment centres in Cameroon was conducted. Only PLWH, receiving treatment in a treatment centre within the country, who had been on treatment for at least six months and who were at least 21 years old were included in the study. Individuals were interviewed about their demographics and ART experiences. Data were collected using a structured interviewer-administered questionnaire and analyzed using STATA version 14.

Results: A total of 451 participants participated in this study, 33.48% were from the country's Southwest region. Their mean age was 43.42 years (SD: 10.42), majority (68.89%) were females. Overall proportion of ART non-adherence among participants was 37.78%, 35.88% missed taking ART twice in the last month. Reasons for missing ART include forgetfulness, business and traveling without drugs. Over half of participants (54.67%) know ART is life-long, 53.88% have missed ART service appointments, 7.32% disbelieve in ART benefits, 28.60% think taking ART gives unwanted HIV Status reminder and 2.00% experienced discrimination seeking ART services. In the multivariate analysis, odds of ART non-adherence in participants aged 41 and above was 0.35 times (95%CI: 0.14, 0.85) that in participants aged 21-30 years, odds of ART non-adherence comparing participants who attained only primary education to those who attained higher than secondary education was 0.57 times (95%CI: 0.33, 0.97) and the odds of ART non-adherence in participants who are nonalcohol consumers was 0.62 times (95%CI: 0.39, 0.98) that in alcohol consumers.

Conclusion: High proportion of participants are ART non-adherent, and the factors significantly associated with ART non-adherence include age, education and alcohol consumption. However, some reasons for missing ART are masked in participants' limited knowledge in taking ART, disbelief in ART benefits, feelings that ART gives unwanted HIV status reminder and experiencing discrimination when seeking ART services. These underscores need to improve staff (health personnel) attitudes, staff-patient-communication, and proper ART prior initiation counselling of patients. Future studies need to focus on assessing long-term ART non-adherence trends and predictors using larger samples in many treatment centres and regions.