Is Antiretroviral Medication Adherence Related to Care Facility? Comparative Study Between HIV Clients in Community Pharmacies and Specialty Clinics in Rivers State Nigeria

Background: Five years after decentralizing HIV care for stable ART clients to community pharmacies in Nigeria, there are still gaps in knowledge on how this influences critical outcomes like adherence to ART among HIV clients. This study compared antiretroviral drug adherence between stable adult HIV clients at community pharmacies and specialty clinics in Rivers State, Nigeria.

Methods: A comparative cross-sectional exit interview was conducted with 174 stable HIV clients in specialty clinics and 174 stable HIV clients in community pharmacies. Adherence to ART was measured using the Morisky Medication Adherence Scale (MMAS 8) and was dichotomized as adherent or non-adherent. The chi-Square test was used for the analysis of dichotomous responses and to compare differences in adherence between facilities.

Results: The community pharmacies had older clients (mean age: CP=43.8 ± 9.1; SC=41.1±10.8; p=0.057) while there was a greater proportion of those below 30 years of age in the specialty clinics (SC=78.6%; CP=21.4%; p=0.014). A greater proportion of CP clients lived in an urban area (CP=54.6%; SC=45.4%; p=0.044) and were employed (CP=56.4%; SC=43.6%; p<0.001) compared to the specialty clinics. Overall, 64.2% and 77.7% of participants reported adherence to ART in specialty clinics and community pharmacies respectively and the gap of 13.8% in favour of community pharmacies was statistically significant (χ2 = 7.290; p=0.007).

Discussion: This study found a significant difference in medication adherence in favour of community pharmacies. This suggests the need for confirmation of this hypothesis using analytic design to inform cascading the ART decentralization program to the remaining LGAs.