Skip to main navigation menu Skip to main content Skip to site footer
Brazilian Journal of Clinical Medicine and Review

Original research

Vol. 3 No. 1 (2025): January/December - 2025

Demographic and Behavioral Determinants Related to ART Adherence Among HIV-Positive Patients in Luanda, Angola

DOI
https://doi.org/10.52600/2965-0968.bjcmr.2025.3.1.bjcmr23
Submitted
September 10, 2024
Published
2024-11-27

Abstract

Adherence to antiretroviral therapy (ART) improves the quality of life of people living with HIV (PLHIV), with emphasis on improving their immune status, reducing viral load and reducing the mortality rate from the Human Immunodeficiency Virus (HIV). To characterize the status of adherence to antiretroviral therapy and the factors associated with non-adherence among adult HIV patients in two health units of reference for people living with HIV/AIDS in Luanda, the capital of Angola (Hospital Divina Providência and Hospital Esperança/Centro de Saúde do Rangel). This is a cross-sectional study of 378 PLHIV on ART, who were interviewed to obtain sociodemographic data and completed a questionnaire to assess ART adherence. It was found that 95.5% of patients had moderate adherence, 4.20% had excellent adherence and 0.3% had poor adherence. Adherence to ART was related to monthly income (p<0.05). In addition, borderline significance was observed between adherence rate and education level, with patients with primary or secondary education having moderate (35% - 50%) or excellent (38% - 56%) adherence rates. Patients over 30 had higher adherence rates, either moderate (30% - 57%) or excellent (44% - 56%). Women had approximately double the rates of moderate (75%) or excellent (63%) adherence to ART compared to men. Low adherence to ART was observed in married individuals and patients who use drugs or alcohol. This study looked at adherence to antiretroviral therapy among HIV-positive individuals in Luanda, Angola. The findings highlight the key role of socioeconomic factors, especially monthly income, in influencing the adherence levels of HIV patients in Angola. In addition, age, gender, education and marital status emerged as additional determinants that negatively affect adherence rates. These determinants emphasize the need for personalized interventions aimed at addressing the various barriers to ART adherence, with the aim of increasing the effectiveness of HIV/AIDS management to ensure a better quality of life for people living with HIV in Angola.

References

  1. UNAIDS. The path that ends AIDS: UNAIDS Global AIDS Update 2023.
  2. Sebastião CS, Neto Z, de Jesus CS, Mirandela M, Jandondo D, Couto-Fernandez JC, et al. Genetic diversity and drug resistance of HIV-1 among infected pregnant women newly diagnosed in Luanda, Angola. PLoS One. 2019;14(11):e0225251. doi: 10.1371/journal.pone.0225251.
  3. Programa Conjunto das Nações Unidas sobre o VIH/SIDA (ONUSIDA). Dados da UNAIDS 2023 – Angola.
  4. Instituto Nacional de Luta contra a SIDA. Normas de Tratamento Antirretroviral. 2015;159.
  5. Cabral JR, Moraes DCA, Cabral LR, Corrêa CA, Oliveira ECS, Oliveira RC. Adesão à terapia antirretroviral e a associação no uso de álcool e substâncias psicoativas. Rev Enferm UFSM. 2017;52.
  6. Zuge SS, Primeira R, Remor E, Magnago TSB, Paula CC, Padoin SMM. Fatores associados à adesão ao tratamento antirre-troviral em adultos infectados pelo HIV: estudo transversal. Rev Enferm UFSM. 2017.
  7. Ahrikat O, Maamar M, Bourkia M, Ammouri W, Bouiga N, Toumi S, et al. Profil épidémiologique et clinique des patients âgés vivant avec le VIH : expérience du center référent de prise en charge de l'infection VIH à Rabat. Rev Med Interne. 2018;39(Suppl 2):A173-A174.
  8. Ngongo NM, Darcis G, Nanituna HS, Mambimbi MM, Maes N, Mashi ML, et al. Longitudinal analysis of sociodemographic, clinical and therapeutic factors of HIV-infected individuals in Kinshasa at antiretroviral therapy initiation during 2006-2017. PLoS One. 2021;16(11):e0259073. doi: 10.1371/journal.pone.0259073. PMID: 34739506; PMCID: PMC8570501.
  9. Raberahona M, Rakotomalala R, Andriananja V, Andriamamonjisoa J, Rakotomijoro E, Andrianasolo RL, et al. A retrospective cohort analysis of people living with HIV/AIDS enrolled in HIV care at a reference center in Antananarivo, Madagascar. Front Public Health. 2024;11:1329194. doi: 10.3389/fpubh.2023.1329194. PMID: 38288430; PMCID: PMC10822960.
  10. Desgrées-du-Loû A, Orne-Gliemann J. Couple-centered testing and counseling for HIV serodiscordant heterosexual couples in sub-Saharan Africa. Reprod Health Matters. 2008;16(32):151-61. doi: 10.1016/S0968-8080(08)32407-0. PMID: 19027631.
  11. Oliveira LB, Queiroz AAFLN, Costa CRB, Magalhães RLB, Araújo TME, Reis RK. Sexual partnerships of people living with HIV/AIDS: Sexual orientation, sociodemographic, clinical and behavioral aspects. Enferm Glob. 2019;18(2):25-62.
  12. Fontenelle PGG, Simão VC, Cavalcante LHB, Barbosa GN, Moura CB, Júnior AMN, et al. Clinical, socioeconomic and envi-ronmental profiles of people living with HIV/AIDS in Roraima. REAmed. 2022;20. doi: 10.25248/REAMed.e11253.
  13. Nogueira VPF, Gomes AMT, Mercês MCD, Couto PLS, Yarid SD, Andrade PCDSTD. Spirituality, religiosity, and their rep-resentations for people living with HIV: Daily life and its experiences. Rev Esc Enferm USP. 2023;57:e20220394. doi: 10.1590/1980-220x-reeusp-2022-0394en.
  14. Santos DFD. Assistance to People Living with HIV/AIDS: Learning to Care for the Virus or the Person? [dissertation]. Rio de Janeiro: State University of Rio de Janeiro - Institute of Social Medicine; 2007.
  15. Carvalho PP, et al. Religiosidade/Espiritualidade e Adesão aos Antirretrovirais. Psico-USF. 2022;27(1):45-60.
  16. Katúmua M. O estado e a religião em Angola. Uma breve análise das dinâmicas relacionais. Rev Sol Nascente. 2021;10(2):Artigo 2.
  17. Jacques IAA, Santana JM, Moraes DC, Souza AFM, Abrão FMS, Oliveira RC. Assessment of adherence to antiretroviral therapy among patients receiving outpatient care. Braz J Health Sci. 2015;18(4):303-8.
  18. Henriques EESL. Effectiveness of a Nursing Intervention Program in symptom management and adherence to antiretroviral therapy in people with HIV/AIDS infection [dissertation]. Lisbon: University of Lisbon; 2019.
  19. World Health Organization. Global status report on alcohol and health 2018 [Internet]. Available from: https://www.who.int/substance_abuse/publications/global_alcohol_report/en/.
  20. Wandera B, Tumwesigye NM, Nankabirwa JI, et al. Alcohol consumption among HIV-infected persons in a large urban HIV clinic in Kampala, Uganda: A constellation of harmful behaviors. PLoS One. 2015;10(5):e0126236.
  21. Minozzi S, Amato L, Davoli M. Development of dependence following treatment with opioid analgesics for pain relief: a systematic review. Addiction. 2013;108(4):688-98.
  22. Friedman SR, Sandoval M, Mateu-Gelabert P, Rossi D, Gwadz M, Dombrowski K, et al. Theory, measurement and hard times: some issues for HIV/AIDS research. AIDS Behav. 2013;17(6):1915-25.
  23. UNAIDS. People Who Inject Drugs [Internet]. 2019 [cited 2021 Oct 20]. Available from: https://www.unaids.org/en/topic/people-who-inject-drugs.
  24. Lima V, et al. Alcohol and illicit drug use are associated with poor antiretroviral therapy adherence: results from a me-ta-analysis of data from the UNAIDS AIDSINFO database. PLoS One. 2021;16(9):e0257480.
  25. Remor E, Milner-Moskovics J, Preussler G. Brazilian adaptation of the Assessment of Adherence to Antiretroviral Therapy Questionnaire. Rev Saude Publica. 2007;41. doi: 10.1590/S0034-89102006005000043.