Gender Disparities and Determinants of Adherence to HIV/AIDS Management among Adults Attending a Tertiary Hospital in Rivers State, Nigeria

Adherence to the management of Human Immunodeficiency Virus and Acquired Immunodeficiency Syndrome is beyond infected persons consistently and accurately taking fixed-dose antiretroviral therapy. This study compared the gender disparity in the self-reported adherence, virologic outcome and factors associated with HIV/AIDS management among HIV-positive adults attending a tertiary hospital in Rivers State, Nigeria.

This concurrent nested mixed-methods approach employed a hospital-based comparative cross-sectional study for the quantitative aspect, and a grounded theory methodology for the qualitative component was conducted at the University of Port Harcourt Teaching Hospital between September and November 2020. Data from the quantitative and qualitative components were collected using a structured interviewer-administered questionnaire and focus group discussion guide to recruit participants through systematic sampling and purposive sampling techniques, then analyzed using Statistical Product and Service Solutions version 25 and ATLAS. Ti version 12, respectively.

A total of 1600 participants (800 males and 800 females) and 24 discussants (12 males and 12 females) were recruited for the quantitative and qualitative aspects of the study, respectively. The mean and standard deviation: Age; male (44.53±10.50) and female (40.58±9.34); self-reported adherence; male (98.7±6.4), female (97.3±10.0), and the virologic suppression; male (89.5%), female (89.6%). The significant predictors of self-reported adherence: Male gender; religion (aOR=0.076, 95%=0.024-0.239, p<0.001), level of education (aOR=0.451, 95% CI=0.213-0.955, p=0.038), and not paying for HIV services (aOR=4.105, 95% CI=1.712-9.792, p<0.001. The only significant predictor of virologic outcome: Female gender; treatment supporter (aOR=0.382, 95% CI=0.206-0.707, p=0.002). The association between self-reported adherence and virologic outcome was not significant: male (89.7%, χ²=0.487, p=0.485), female (90%, χ²=1.227, p=0.268). The focus group discussion reported that socio-cultural, socioeconomic and psychosocial challenges negatively influenced treatment adherence. 

The identified factors significantly influenced the gender difference in self-reported adherence as opposed to the virologic outcome. Hence, responsible organizations should develop measures to improve virologic outcomes.