Determinants of non-adherence to antiretroviral therapy among displaced people living with HIV and comparison with host populations: a cross-sectional study in Ituri and North Kivu

TL;DR

This study compares HIV medication adherence between displaced people and local residents in conflict-affected regions of DR Congo, finding higher non-adherence among displaced individuals.

Contribution

Identifies unique adherence barriers for displaced HIV patients and compares them to host populations in a conflict zone.

Findings

Displaced PLHIV had significantly higher non-adherence (30%) compared to host populations (21%).

Key determinants of non-adherence included long travel time to hospitals, patient dissatisfaction, opportunistic infections, and stigma.

Abstract

little information is available on the extent of HIV and Antiretroviral therapy (ART) adherence among displaced people living with HIV (PLHIV). The objective of this study was to compare the prevalence of ART non-adherence between displaced PLWHIV and the host population, and to identify determinants of non-adherence to ART among displaced PLHIV.

a cross-sectional analytical study involving 444 adults living with HIV, both displaced persons and hosts, was conducted in Ituri and North Kivu from November 2022 to January 2023. Adherence was assessed based on patient reports and prescription refills. Logistic regression in SPSS 25 was performed to identify determinants of non-adherence to ART.

the prevalence of non-adherence was higher among displaced PLWHIV compared to those in the host population: 30% (24%-36%) vs 21% (18%-23%), p= 0.002. Non-adherence among displaced PLHIV was not different between the two provinces: 26% (18%-34%) in Ituri vs 34% (26%- 43%), p= 0.09 in North-Kivu. The main reasons for not taking ART among displaced PLWHIV were: forgetfulness, lack of food, occupation and travel. Multivariate analysis identified camp-to-hospital time greater than one hour (aOR: 2.32; CI 95%: 1.21 - 7.20), patient dissatisfaction (aOR: 6.20; 95% CI: 2.16 - 17.74), opportunistic infections (aOR: 5.32; CI 95%: 1.86 - 15.57), and stigma (aOR: 7.31; CI 95%: 2.82 - 18.84) as determinants of non-adherence.

forced displacement favors non-adherence to ART. The specificities of displaced PLHIV require specific strategies to improve their retention on ART in order to reduce HIV-related morbidity and mortality.

Figures