Adherence to Antiretroviral Therapy (ART) and Associated FactorsAmong Adult HIV Patients at the Benue State University TeachingHospital, Makurdi, Nigeria
Keywords:
Adherence, Antiretroviral therapy, Adult HIV patients, Makurdi, NigeriaAbstract
Background: Human Immunodeficiency Virus (HIV) infection remains a major global public health problem despite
significant progress in prevention, diagnosis, and treatment. In 2024, approximately 31.6 million people living with HIV
(PLHIV) were receiving antiretroviral therapy (ART) globally, while about 76% of PLHIV in West and Central Africa
were on ART. However, ART coverage reflects treatment access rather than treatment success. Optimal outcomes depend
on ART adherence, traditionally defined as taking ≥95% of prescribed doses. This study assessed the level of ART
adherence among adult HIV patients at Benue State University Teaching Hospital, Makurdi, Nigeria, and identified the
facilitators, barriers, and determinants of adherence.
Methodology: A cross-sectional descriptive study was conducted among HIV-positive adults attending the ART clinic.
Respondents were selected using systematic random sampling. Data were collected between November and December
2025 using pre-tested, interviewer-administered questionnaires. Adherence was measured by patient self-report as the
proportion of prescribed doses taken over the preceding three days. Data were analyzed using SPSS version 27.
Descriptive statistics (frequencies, percentages, and means ± SD) were used to summarize data. Crude odds ratios (COR)
and adjusted odds ratios (AOR) were calculated to identify factors associated with adherence. Statistical significance was
set at p < 0.05.
Results: Of the 298 respondents, 91 (30.5%) were males and 207 (69.5%) females, with a mean age of 38.94 ± 12.64
years. Overall, 86.6% reported good adherence, while 13.4% were non-adherent. Reported facilitators included
confidence in taking ART as prescribed (95.3%), keeping medications in visible locations (94.6%), social support
(62.4%), and use of reminders (55.4%). Reported barriers included fear of disclosure or stigma (15.1%), being away from
home (8.4%), running out of ARVs (7.0%), and being busy (5.7%). Confidence in taking ART as prescribed was a
significant predictor of adherence (AOR = 7.60, 95% CI: 1.11–51.81, p = 0.038). Being away from home (AOR = 0.005,
95% CI: 0.001–0.032, p < 0.001) and running out of ARVs (AOR = 0.003, 95% CI: 0.000–0.038, p < 0.001) were
associated with significantly lower odds of adherence. Other variables were not significant after adjustment.
Conclusion: ART adherence was high among respondents. The main facilitator predicting adherence was confidence in
taking ART as prescribed, while key barriers predicting lower odds of adherence were being away from home and
running out of medication. Interventions aimed at enhancing self-efficacy, strengthening social support systems,
promoting the use of reminders, and encouraging advance planning for medication refills - especially during travel - may
further improve adherence.
References
1. Joint United Nations Programme on HIV/AIDS
Shaahu VN*, et al., Adherence to Antiretroviral Therapy (ART) and Associated Factors Among Adult HIV Patients
J Biomed Res. Clin Pract | Vol 9 | No 2 | 2026 67 For Reprint Contact: info@jbrcp.org
(UNAIDS). Global HIV & AIDS statistics - Fact
sheet. Geneva: UNAIDS; 2025. Retrieved on 23
F e b r u a r y , 2 0 2 6 . A v a i l a b l e f r o m :
2. Joint United Nations Programme on HIV/AIDS
(UNAIDS). Regional profile: Western and Central
Africa. Geneva: UNAIDS; 2025. Retrieved on 23
F e b r u a r y , 2 0 2 6 . A v a i l a b l e f r o m :
nttps://www.unaids.org
3. Federal Ministry of Health (FMOH) Nigeria.
Nigeria HIV/AIDS Indicator and Impact Survey
(NAIIS) 2018: Technical Report. Abuja: FMOH;
2019.
4. National Agency for the Control of AIDS (NACA).
Nigeria National Response Information
Management System operational plan III
(2021–2025). Abuja: NACA; 2021.
5. Parve NV, Gurav AP, Mhetre RL, Dhole SN,
Kulkarni NS. Transforming HIV care: The power
of antiretroviral drugs. Biosci., Biotechnol. Res.
Asia. 2025;22(4):1443-1461.
6. Pau AK, George JM. Antiretroviral therapy: current
drugs. Infect Dis Clin North Am. 2014;28(3):371-
402. doi: 10.1016/j.idc.2014.06.001.
7. Kemnic TR, Gulick PG. HIV antiretroviral therapy.
In: StatPearls. Treasure Island (FL): StatPearls
Publishing; 2022. Retrieved on 18 March, 2026.
A v a i l a b l e f r o m :
https://www.ncbi.nlm.nih.gov/books/
8. Kasamba I, Baisley K, Mayanja BN, Maher D,
Grosskurth H. The impact of antiretroviral
treatment on mortality trends of HIV-positive
adults in rural Uganda: a longitudinal populationbased
study, 1999–2009. Trop Med Int Health.
2012;17(8):e66–e73. doi:10.1111/j.1365-
3156.2012.02841.x
9. Zhao Y, Wu Z, McGoogan JM, Shi CX, Li A, Dou Z,
et al. Immediate antiretroviral therapy decreases
mortality among patients with high CD4 counts in
China: a nationwide, retrospective cohort study.
C l i n I n f e c t D i s . 2 0 1 8 ; 6 6 ( 5 ) : 7 2 7 – 7 3 4 .
doi:10.1093/cid/cix878.
10. Pimentel GS, Ceccato MGB, Costa JO, Mendes JC,
Bonolo PF, Silveira MR. Quality of life in
individuals initiating antiretroviral therapy: a
cohort study. Rev Saude Publica. 2020;54:146.
doi:10.11606/s1518-8787.2020054002023.
11. Paterson DL, Swindells S, Mohr J, Brester M,
Vergis EN, Squier C, et al. Adherence to protease
inhibitor therapy and outcomes in patients with
H I V i n f e c t i o n . A n n I n t e r n M e d .
2000;133(1):21–30. doi:10.7326/0003-4819-133-
1-200007040-00004.
12. Byrd KK, Hou JG, Hazen R, Davis SL, Stein CM,
Bangsberg DR. Antiretroviral adherence level
necessary for HIV viral suppression using realworld
data. J Acquir Immune Defic Syndr. 2019;
8 2 ( 3 ) : 2 4 5 – 2 5 1 .
doi:10.1097/QAI.0000000000002142.
13. Mills EJ, Nachega JB, Buchan I, Orbinski J, Attaran
A, Singh S, et al. Adherence to antiretroviral
therapy in sub-Saharan Africa and North America: a
meta-analysis. JAMA. 2006;296(6):679-690. doi:
10.1001/jama.296.6.679.
14. Kim SH, Gerver SM, Fidler S, Ward H. Adherence
to antiretroviral therapy in adolescents living with
HIV: systematic review and meta-analysis. AIDS
2014;28:1945–1956.
15. Almeida P, Rafael C, Pimentel V, Abecasis A,
Sebastião C, Morais J. Adherence to antiretroviral
therapy (ART) among HIV-1 patients from sub-
Saharan Africa: a systematic review. AIDS Rev.
2 0 2 4 ; 2 6 ( 3 ) : 1 0 2 - 1 1 0 .
d o i : 1 0 . 2 4 8 7 5 / a i d s r e v. 2 4 0 0 0 0 0 4 . P M I D :
39466708.
16. Angelo AT, Alemayehu DS. Adherence and Its
Associated Factors Among Adult HIV-Infected
Patients on Antiretroviral Therapy in South
Western Ethiopia, 2020. Patient Prefer Adherence.
2021;15:299-308. doi: 10.2147/PPA.S298594.
PMID: 33603348; PMCID: PMC7886248.
17. Jones HS, Floyd S, Stangl A, Bond V, Hoddinott G,
Shaahu VN*, et al., Adherence to Antiretroviral Therapy (ART) and Associated Factors Among Adult HIV Patients
J Biomed Res. Clin Pract | Vol 9 | No 2 | 2026 68 For Reprint Contact: info@jbrcp.org
Pliakas T, et al. Association between HIV stigma
and antiretroviral therapy adherence among adults
living with HIV: baseline findings from the HPTN
071 (PopART) trial in Zambia and South Africa.
Trop Med Int Health. 2020;25(10):1246–1260.
doi:10.1111/tmi.13473.
18. Abatur SC, Angahar JI, Tyokumba J, Injor RI,
Anweh BT, Amgah ST. Adherence challenges: a
cross-sectional study of patients on antiretroviral
therapy in a tertiary hospital in North Central
Nigeria. West Afr J Pharm. 2023;34(1):70–82.
19. World Health Organization (WHO). Consolidated
guidelines on the use of antiretroviral drugs for
treating and preventing HIV infection:
recommendations for a public health approach. 2nd
ed. Geneva: WHO; 2016.
20. Joint United Nations Programme on HIV/AIDS
(UNAIDS). Global AIDS update 2023: the path
that ends AIDS. Geneva: UNAIDS; 2023.
21. National Population Commission (NPC). Nigeria
Population Projections and Demographic
Indicators. National and States. . Abuja:
NPC;2020. Retrieved on 21 March 2026. Available
from :
https://www.nationalpopulation.gov.ng/publicatio
n
22. Federal Ministry of Health (FMOH) Nigeria.
National Guidelines for HIV Prevention,
Treatment and Care. National AIDS and STIs
Control Programme. Abuja: FMOH; 2020.
23. Saenjun P, Vongsirimas N, Klainin-Yobas P. Factors
influencing antiretroviral therapy adherence
among youth living with HIV: a systematic review
and meta-analysis. BMC Public Health.
2 0 2 5 ; 2 5 : 4 2 1 3 . A v a i l a b l e f r o m :
https://doi.org/10.1186/s12889-025-25357-6
24. Chen H, Long R, Hu T, Chen Y, Wang R, Liu Y, et al.
A model to predict adherence to antiretroviral
therapy among people living with HIV. Sex Transm
I n f e c t . 2 0 2 2 ; 9 8 ( 6 ) : 4 3 8 – 4 4 4 .
doi:10.1136/sextrans-2021-055222.
25. Magdy M, Zaki A, Osman SO, Abd El-Wahab EW,
Abd Elhameed A. Predictors of adherence to
antiretroviral therapy among people living with
HIV in Northern Egypt. Ann Glob Health.
2024;90(1):58. doi:10.5334/aogh.4491.
26. Hosseini Z, Rad RE, Shahabi N, Mohseni S, Azad
MH, Aghamolaei, et al. Relationship between selfefficacy
and adherence to antiretroviral therapy in
HIV/AIDS patients: an analytical cross-sectional
study in southern Iran. Health Sci Rep. 2024;
7:e1879. doi:10.1002/hsr2.1879.
27. Ashaba S, Baguma C, Tushemereirwe P, Nansera D,
Maling S, Zanon BC, et al. Correlates of HIV
treatment adherence self-efficacy among
adolescents and young adults living with HIV in
southwestern Uganda. PLOS Glob Public Health.
2 0 2 4 ; 4 ( 9 ) : e 0 0 0 3 6 0 0 . Av a i l a b l e f r o m :
https://doi.org/10.1371/journal.pgph.0003600
28. Addo MK, Aboagye RG, Tarkang EE. Factors
influencing adherence to antiretroviral therapy
among HIV/AIDS patients in the Ga West
M u n i c i p a l i t y, G h a n a . I J I D R e g i o n s .
2022;3:218–225.
29. Croome N, Ahluwalia M, Hughes LD, Abas M.
Patient-reported barriers and facilitators to
antiretroviral adherence in sub-Saharan Africa.
AIDS. 2017;31(8):995–1007.
30. Jayte M, Mohamed AA, Karshe A, Abdi FD, Araye
FA, Adan AS. Exploring multilevel barriers and
facilitators to antiretroviral therapy adherence
among adults living with HIV in ART clinic in
Mogadishu, Somalia: a qualitative study guided by
the socio-ecological model. AIDS Res Ther. 2026;
2 3 ( 1 ) : 1 . A v a i l a b l e
from:https://doi.org/101186/s12981-025-00830-9
31. Lahai M, Theobald S, Wurie HR, Lakoh S, Erah PO,
Samai M, et al. Factors influencing adherence to
antiretroviral therapy from the experience of people
living with HIV and their healthcare providers in
Sierra Leone: a qualitative study. BMC Health Serv
Res. 2022;22:1327. doi:10.1186/s12913-022-08606-x.32.
32. Uzoma CM. Factors affecting adherence to ART by
people living with HIV/AIDS in Nigeria: a
systematic review. Int J Innov Res Adv Stud.
2024;11(6).
33. Magura J, Nhari SR, Nzimakwe TI. Barriers to ART
adherence in sub-Saharan Africa: a scoping review
toward achieving UNAIDS 95-95-95 targets. Front
P u b l i c H e a l t h . 2 0 2 5 ; 1 3 : 1 6 0 9 7 4 3 . d o i :
10.3389/fpubh.2025.1609743.
