Comorbidities And Antiretroviral Therapy Adherence Among Aged Hiv-Positive Clients In Western North Region, Ghana

Abstract

Background: Access to antiretroviral therapy in low-and middle-income countries has improved, leading to an increase in the number of the aged (≥ 50 years) living with HIV. Antiretroviral medication adherence has proven to increase longevity and the quality of life of people living with HIV. The age cut-off used to describe the elderly in HIV, is 50 years. Reports provide little information on over 50 years. Additionally, HIV interventions or programmes are mostly targeted at children, the youth or adults (15 – 49 years), and the general information on the aged (50 years and above) population is relatively poor. Objective: The objective of the study was to examine the influence of comorbidities on ART adherence, and to assess the quality of life among aged HIV-positive clients. Methods: A cross-sectional design that combined service records review and quantitative interviews was done. A total of 331 aged HIV positive patients on ART participated from the Aowin Municipality, Sefwi Wiawso Municipality and Suaman District of the Western North Region. The interviews were done using an electronic based data collection tool, KoBoCollect. Quantitative data analysis was done using Stata IC software version 16. Results: The study observed a 28% comorbidity prevalence with 29% of them reporting a minimum of two comorbidities. Females were 57% of the total respondents. Adherence was high at about 83%. Reasons for non-adherence were found to be stigma [OR = 0.31(95% CI: 0.12, 0.80)], pill fatigue [ OR = 0.37(95% CI: 0.16, 0.85)] and lack of support from family or significant others [OR= 0.33 (95% CI: 0.14, 0.78)] were found to negatively affect adherence. The overall quality of life was about 65% and this was evaluated from facet scores (1 = very poor and 5 = very good) using the WHO Quality of Life Instrument for HIV. The facets scores were added to get the domain scores (4 = very poor and 20 = very good QOL). The average domain scores were calculated for the overall QOL of respondents. Conclusion: Adherence among the aged HIV population is relatively high. However, stigma, pill fatigue and no support from family or significant others impact adherence to ART negatively. Notwithstanding, the overall quality of life was good among this group of PLHIV. Cardiovascular disease was prevalent among the aged PLHIV. Mental health disorders were the least among the aged HIV population. Further research to be done to assess the mental health status of aged HIV- positive clients in the region.