Factors Associated With Antiretroviral Therapy Adherence amongst Men Who Have Sex with Men in Selected Facilities

Abstract

Background: Current increase in HIV prevalence among MSM in Greater Accra region of Ghana is a public health concern. This increase translates to higher number of MSM being put on antiretroviral treatment. However, ART adherence amongst HIV positive MSM in Ghana is unknown. Lack of knowledge in ART adherence among MSM could affect the implementation of the 90-90-90 fast track targets. This study therefore sought to determine the level of ART adherence and factors influencing adherence amongst MSM in the Greater Accra region of Ghana. Methods: This was a cross sectional study which employed a quantitative method. The study was conducted in four selected facilities in the Greater Accra region from the period of April 13th to June 29th, 2018. Through the assistance of ART ‗case managers‘, 223 participants on ART across the four selected facilities were recruited for self-administered questions and interviewed on ART adherence. Structured questionnaires were administered and analysis of quantitative data was done using Stata15. Confidence Interval was set at 95% and p-value <0.05 for statistical significance. The Pearson‘s Chi-square was used to test association between factors and ART adherence. Multiple logistics regression model was used to quantify the adjusted effects of the various factors on ART adherence. Results: A total of 233 HIV positive MSM with a median age 24 years participated in the study. Just a third 87(39%, 95% CI: 32.57, 45.75) of participants adhered to ART. Criminalization of homosexuality was positively associated with ART adherence (p<0.033). Fear of gender discrimination limiting sexual orientation disclosure for a holistic ART service was also significantly associated with ART adherence (p<0.021). Conclusions: This study demonstrated that ART adherence amongst MSM in the Greater Accra region was low. Fear of gender discrimination limiting sexual orientation disclosure for a holistic ART service were found to be a factor associated with the low ART adherence. This can impede strategies to achieve the 2nd and 3rd 90 of the UNAIDS 90-90-90 HIV treatment targets among MSM. Also, criminalization of homosexuality as perceived to be associated with ART adherence was unsupported, and the perceived ART service disparity between homosexuals and heterosexuals was not associated with ART adherence. We recommend that Intensive ART adherence education and counseling should be provided by Ghana AIDS Commission and partnered Civil Society Organizations (CSOs) with HIV programming for MSM. The Ghana AIDS Commission should promote rigorous CSOs Advocacy and intervention on eliminating fear of gender discrimination associated with sexual orientation disclosure and ART adherence.