Economic empowerment of HIV patients boosts adherence to antiretroviral drugs – Study

A pilot study by NIMR’s Grant Monitoring and Evaluation unit shows that adherence failure to ARVs could be reduced if patients benefit from some form of economic empowerment.

Inability of patients to take their medications as prescribed, has been identified as a significant problem in HIV/AIDS management, resulting in viral suppression failure, drug resistance, and treatment failure.

Presenting the study titled “Empowerment Models for Improving Human Immunodeficiency Virus (HIV) Patients’ Adherence to Antiretroviral Drugs”, at the Institute’s monthly seminar held on Wednesday May 28, Dr. Kazeem Osuolale, a Senior Research Fellow, observed that while several methods for improving adherence to ARTs such as directly observed therapy, dose simplification, phone reminders and counselling among other strategies have been published, little attention has been paid to empowerment intervention, especially in the developing world, like Nigeria.

“In Nigeria, poverty remains a grave concern, as large segments of the population are poor in both physical and economic terms,” he noted, adding that economic hardship limits access and commitment to ART “thus finding solutions to non-adherence caused by inadequate or no regular income by patients could improve adherence to picking up and taking medication as and when due.

“This is citical, as the need to feed, transport, pay for registration fees at the clinic and other financial challenges are attached to this, even if the drugs are given free of charge.” he said.

Dr. Osuolale disclosed that the study which was conducted between July 2021 and February 2023 was designed to evaluate the impact of a skilled acquisition empowerment intervention on ART adherence among HIV patients in Nigeria. Thus, the objective was to determine the significant differences in adherence rate before and after the empowerment interventions for the experimental group and the control group and also to compare ART adherence of HIV patients who participate in the skills acquisition program and ART adherence of a group that does not participate in the program.

The pilot study involved 50 willing patients aged 15 to 45 years who have been on antiretroviral therapy for at least three months at NIMR’s HIV Care and Treatment Center and with documented adherence below 95%. Participants were grouped in either the experimental or control groups.

Dr. Osuolale

“The skills acquisition model as a piece of empowerment program was in two phases. During the phase one, we had over four lectures (and) in phase two, we engaged on practical vocational training that involved catering, bead making, liquid soap making and hair knitting. The participants received start up materials just after the skill acquisition program and they were followed up over three months”.

While there were no significant differences in the two groups of participants in areas such as age, marital status, occupation, level of education, researchers however observed a significant difference in the monthly income between the experimental group and the control group. While 16 out of 25 participants have their income between 0 to 15,000 Naira in the experimental group. Only 8 of the participants in the control group have income between 0 to 15,000 Naira. There was however no significant difference in the source of income between the two groups.

Dr. Osuolale presented the findings of the study showing that the experimental group which had access to empowerment recorded better adherence to ARVs than the control group.

“if you look at the experimental group, which is having 0.25. before the intervention, the range (was) between 27% and 92% of adherence and the mean is 68.7%.

“Now, for the control, before the intervention, it’s between 39 and 92, and the mean is 83.66. And after the intervention, it’s 99.44. Meanwhile, if you look at the experimental group it increases from 68.76 to 109.72. So, what it means is that, for the experimental group, the adherence rate increased. It surpasses that of the control group.

“Then, comparing the two, experimental group and control group, if you look at the experimental group, the range is 27 to 92 and the mean is 68.76. For the control group, between 39 and 92, that is the range and the mean is 83.66.
So, if you look at that of experimental, it increases from 68.76 to 109.72, whereas for control, from 83.66 to 99.44, which means post-intervention, the experimental group surpasses the control group in terms of adherence rate that we have, which is fairly significant. But, when you compare the experimental and the control, before, and when you compare the experimental group and control group, post-intervention, which is 0.044, it is also significant.

“This study confirmed the effectiveness of skill acquisition in improving ART adherence. Economic empowerment directly addressed barriers such as transportation costs and financial stress, enabling consistent medication use.

Dr. Osuolale however acknowledged the limitation of the study due to its small sample size which could limit how widely the findings can be applied and also its short-term follow-up, of about three months, which makes it impossible to assess the intervention’s lasting effect. He therefore recommended future research with larger samples and longer follow-up periods.

Source: NIMR