Baseline characteristics
From September to October 2017, 260 PLHIV were invited to participate in an interview. Among them, 18 PLHIV refused to participate. The response rate was 93.1%. Eight PLHIV were excluded (3 PLHIV were unable to answer and 5 PLHIV did not complete the interview). A total of 234 PLHIV were included. Characteristics of PLHIV interviewed are detailed in Table
1. Participants were predominantly male. Median (IQR) age of male participants was lower than female participants: 32 years (IQR: 25–41) vs 34 years (IQR: 30–46),
p = 0.008. Most of the participants were heterosexual (
n = 138, 59%), single (
n = 134, 57.3%), had high level of education (
n = 115, 49.5%) and were currently employed (
n = 141, 60.3%).
Table 1
Characteristics of PLHIV interviewed
Age in years (median, IQR) | 33 (27–41) |
Male | 176 (75.2) |
Sexual orientation |
• Heterosexual | 138 (59) |
• Homosexual | 35 (15) |
• Bisexual | 61 (26) |
Marital status |
• Single | 134 (57.3) |
• Married | 76 (32.5) |
• Divorced | 14 (6) |
• Widowed | 10 (4.3) |
Educational level |
• Illiterate | 2 (0.9) |
• Primary | 11 (4.7) |
• Secondary | 106 (45.3) |
• Postgraduate | 115 (49.5) |
Currently employed | 141 (60.3) |
Student | 44 (18.8) |
Unemployed | 49 (20.9) |
Member of PLHIV association | 31 (13.2) |
Lives with other people | 181 (77.4) |
Number of people living under the same roof (median, IQR) | 4 (3–5) |
Disclosure of HIV status | 163 (69.7) |
Diagnosis of HIV in months (median, IQR) | 25 (9–56) |
• < 6 months | 31 (13.2) |
• 6–11 months | 40 (17.1) |
• 12–23 months | 41 (17.5) |
• 24–35 months | 19 (8.1) |
• ≥36 months | 103 (44) |
Duration of ART in months (median, IQR) | 18 (8–48) |
• < 6 months | 37 (15.8) |
• 6–11 months | 46 (19.7) |
• 12–23 months | 40 (18.4) |
• 24–35 months | 28 (12.6) |
• ≥36 months | 80 (34.2) |
ART regimen |
• TDF/3TC/EFV (1st line regimen) | 212 (90.6) |
• ABC/3TC/ATVr | 15 (6.4) |
• AZT/3TC/LPVr | 2 (0.9) |
• AZT/3TC/ATVr | 1 (0.4) |
• TDF/3TC/ATVr | 2 (0.9) |
• ABC/3TC/LPVr | 2 (0.9) |
Patient educational interventions | 191 (81.6) |
Among patients who have disclosed their HIV status, 56 (34.4%) have disclosed to their spouse, 36 (22.1%) to their mother, 21 (12.9%) to their father, 20 (12.3%) to their brother, 28 (17.2%) to their sister, 8 (4.9%) to their children, 28 (17.2%) to their friend, 28 (17.2%) to their sexual partner and 37 (22.7%) to people other than the medical staff. Among patients who have had educational interventions, 147 (77%) received educational interventions including education on HIV/AIDS and ART by referring physicians, 53 (27.7%) by ART dispensing staff, 23 (12%) by patient association, 11 (5.8%) by psychosocial support service and 22 (11.5%) by other stakeholders.
Knowledge of ART
The assessment of knowledge of ART is detailed in Table
2. Median score for knowledge of ART was 7 (IQR: 6–8). Most of the participants exhibited a good knowledge (score ≥ 6) of ART (
n = 205, 87.6%). However, only 9 participants (3.8%) were able to name their ART (brand name and/or name of all components of the ART regimen). Most of the participants knew that ART should be taken for lifetime. However, 25 participants gave other answers: ART should be taken until healing (
n = 12), until the physician decided to stop it (
n = 6), until viral load is undetectable (
n = 4), during 6 months (
n = 1), until CD4 count is equal or more than 500 per mm
3 (
n = 1) and for 4 years (
n = 1).
What is the name of your ART? |
• Correct answer | 9 (3.8) |
• Incorrect answer | 225 (96.2) |
How many tablets should you take each day for your ART? |
• Correct answer | 228 (97.4) |
• Incorrect answer | 6 (2.6) |
How should you take your ART? |
• At fixed timea | 73 (31.2) |
• At variable time | 161 (68.8) |
How should you take your ART in relation to food intake? |
• Correct answer | 40 (17.1) |
• Incorrect answer | 194 (82.9) |
Has your ART regimen already been modified? |
• Correct answer | 193 (82.5) |
• Incorrect answer | 41 (17.5) |
How long should you take your ART? |
• Lifetime treatmenta | 195 (83.3) |
• Other answer | 25 (10.7) |
• Don’t know | 14 (6.0) |
What is the purpose of ART? |
• Suppress the activity of HIV but do not curea | 214 (91.5) |
• Cure HIV/AIDS | 20 (8.5) |
What is the effect of ART on HIV viral load? |
• Decrease HIV viral loada | 169 (72.2) |
• Other answer | 44 (18.8) |
• Don’t know | 21 (9.0) |
What is the effect of ART on CD4 count? |
• Increase CD4 counta | 203 (86.8) |
• Other answer | 11 (4.7) |
• Don’t know | 20 (8.5) |
What is the effect of missed doses on treatment efficiency? |
• Can reduce treatment efficiencya | 204 (87.2) |
• No effect | 11 (4.7) |
• Don’t know | 19 (8.1) |
Can ART prevent mother-to-child transmission of HIV? |
• Yesa | 144 (61.5) |
• No | 60 (25.6) |
• Don’t know | 30 (12.8) |
Participants who were not single have a significantly higher knowledge of the name of their ART than those who were single (7% vs 1.5%, p = 0.040). A significantly higher proportion of women were unaware of the dose of their ART compared to men (6.9% vs 1.1%, p = 0.035). The knowledge of treatment schedule was significantly higher in participants who were members of PLHIV associations (48.4% vs 28.6%, p = 0.027) and in participants who were not on first line ART regimen (68.2% vs 27.4%, p < 0.001). A significantly higher proportion of women were unaware of the history of their ART medication compared to men (29.3% vs 13.6%, p = 0.006). PLHIV who were diagnosed with HIV for less than 6 months (35% vs 11.2%, p = 0.008) or who were on ART for less than 6 months (35% vs 14%, p = 0.023) were significantly unaware of the purpose of ART compared to those who were not. Likewise, the proportion of PLHIV who were unaware of the purpose of ART was significantly lower in those who were single compared to those who were not (5.2% vs 13%, p = 0.035). The knowledge of the effect of ART on CD4 count was significantly higher in participants with a postgraduate level compared those with a lower level of education (92.2% vs 0%, p = 0.008). Similarly, the knowledge of the effect of ART on HIV viral load was higher in participants with a postgraduate level, however, this result did not reach statistical significance (76.5% vs 0%, p = 0.06). The knowledge of the preventive effect of the ART on mother-to-child transmission of HIV infection were significantly higher in PLHIV < 40 years (65.9% vs 50.7%, p = 0.032) and in PLHIV who do not live alone (65.2% vs 49.1%, p = 0.034).
In univariate analysis (Table
3), age < 40 years (OR: 2.7, 95%CI: 1.2–5.9,
p = 0.012), postgraduate level (OR: 4.3, 95%CI: 1.7–11.1,
p = 0.001), PLHIV currently employed and being student (OR: 2.7, 95%CI: 1.2–6.2,
p = 0.016), disclosure of HIV status (OR: 2.4, 95%CI: 1.1–5.3,
p = 0.025) and duration of ART≥6 months (OR: 2.8, 95%CI: 1.2–6.9,
p = 0.016) were associated with good knowledge of ART.
Table 3
Factors associated with good knowledge of ART
Age < 40 years | 15 (51.7) | 152 (74.1) | 2.7 (1.2–5.9) | 0.012 | 1.9 (0.8–4.7) | 0.147 |
Male | 20 (69.0) | 156 (76.1) | 1.4 (0.6–3.3) | 0.405 | | |
Heterosexual | 20 (69.0) | 118 (57.6) | 0.6 (0.3–1.4) | 0.243 | | |
Single | 15 (51.7) | 119 (58.0) | 1.3 (0.6–2.8) | 0.519 | | |
Postgraduate level | 6 (20.7) | 109 (53.2) | 4.3 (1.7–11.1) | 0.001 | 4.7 (1.6–13.7) | 0.004 |
Currently employed and student | 18 (62.1) | 167 (81.5) | 2.7 (1.2–6.2) | 0.016 | | |
Member of PLHIV association | 3 (10.3) | 28 (13.7) | 1.4 (0.4–4.8) | 0.622 | | |
Lives with other people | 21 (72.4) | 160 (78.0) | 1.4 (0.6–3.3) | 0.497 | | |
Disclosure of HIV status | 15 (51.7) | 148 (72.2) | 2.4 (1.1–5.3) | 0.025 | 2.7 (1.1–6.6) | 0.029 |
Patient educational interventions | 24 (82.8) | 167 (81.5) | 0.9 (0.3–2.6) | 0.866 | | |
Diagnosis of HIV ≥ 6 months | 22 (75.9) | 181 (88.3) | 2.4 (0.9–6.2) | 0.065 | 0.5 (0.1–3.6) | 0.464 |
Duration of ART ≥6 months | 20 (69.0) | 177 (86.3) | 2.8 (1.2–6.9) | 0.016 | 6.4 (0.9–43.3) | 0.058 |
1st line ART regimen | 29 (100.0) | 183 (89.3) | – | 0.085 | – | 0.998 |
In multivariate analysis, factors associated with good knowledge of ART (Table
3) were postgraduate level (aOR: 4.7, 95%CI: 1.6–13.7,
p = 0.004) and disclosure of HIV status (aOR: 2.7, 95%CI: 1.1–6.6,
p = 0.029).
Attitude and perception of ART
The assessment of attitude and perception towards ART is detailed in Table
4. Median score for attitude and perception was 5 (IQR: 5–6). Most of the participants had a positive attitude and perception (score ≥ 5) towards ART (
n = 177, 75.6%). Fifty-seven participants (24.4%) had negative attitude and perception. Among the 25 participants who believed in more effective method than ART for treating HIV, 10 participants refused to reveal the method they believed to be more effective than ART, 6 participants believed that religion is more effective, 5 participants believed that herbal medicine is more effective, 3 participants thought that there is more effective method than ART but they currently don’t know which one and 1 participant believed that healthy lifestyle is more effective than ART.
Table 4
Attitude and perception of ART
Do you believe that there are other more effective methods to treat HIV than ART? |
• Yes | 25 (10.7) |
• Noa | 209 (89.3) |
Are you convinced of being infected by HIV? |
• Yesa | 177 (75.6) |
• No | 57 (24.4) |
Are you convinced of the effectiveness of ART? |
• Yesa | 216 (92.3) |
• No | 18 (7.7) |
Do you think that taking ART does more harm than good? |
• Yes | 31 (13.2) |
• Noa | 203 (86.8) |
Are you convinced that you should continue your ART? |
• Yesa | 229 (97.9) |
• No | 5 (2.1) |
Do you feel ashamed to take your ART? |
• Yes | 100 (42.7) |
• Noa | 134 (57.3) |
There were more participants who were convinced that there were other more effective methods than ART for treating HIV among those who were unemployed compared to those who were employed or student (18.4% vs 8.6%, p = 0.05). However, the result did not reach statistical significance. A significantly higher proportion of PLHIV with a diagnosis of HIV < 6 months were more convinced not being infected with HIV compared to those with a diagnosis of HIV ≥6 months (38.7% vs 22.2%, p = 0.046). In addition, a significantly higher proportion of PLHIV who were unemployed were convinced that ART does more harm than good compared to those who were employed or student (22.4% vs 10.8%, p = 0.033).
We did not identify factors associated with positive attitude and perception of ART in univariate and multivariate analysis.
Practice regarding ART
Practice regarding ART was assessed and detailed in Table
5. We asked each participant for the choice of ART storage location at their home. One hundred forty-eight participants (63.2%) chose to store their medication “hidden and out of sight”, 77 participants (32.9%) chose a convenient storage but not necessarily suitable as recommended by the manufacturer, 55 participants (23.5%) chose a storage that can help to remember ART daily schedule, 45 participants (19.2%) chose a storage out of the reach and sight of children and 32 participants (13.7%) chose a suitable storage as recommended by the manufacturer. Most of the participants (
n = 171, 73.1%) chose to store ART without its original carton packaging. In addition, 5 participants (2.1%) decided to store ART without its original plastic packaging and 11 participants (4.7%) stored ART in other plastic packaging.
Table 5
Practice regarding ART
Reasons for missed doses of ART (n = 151) |
• Can’t swallow pills | 3 (2.0) |
• Lack of information | 1 (0.7) |
• Busy doing something else | 16 (10.6) |
• Away from home | 47 (31.1) |
• Difficulty to comply with prescribed schedule | 14 (9.3) |
• Forgetting | 56 (23.9) |
• Health problem | 8 (5.3) |
• Too many tablets to take | 3 (2.0) |
• Other reasons | 68 (45.0) |
Method to remember to take ART |
• No particular method (habits) | 190 (81.2) |
• Help from a relative | 28 (12.0) |
• Reminder device | 37 (15.8) |
• Other | 7 (3.0) |
Practices in the event of missed dose of ART |
• Skip the missed dose and take the next dose planned | 113 (48.3) |
• Take the missed dose the next morning | 74 (31.6) |
• Call the referring physician | 18 (7.7) |
• Come to the hospital | 14 (6.0) |
• Take the missed dose as soon as possible | 6 (2.6) |
• Don’t know what to do | 6 (2.6) |
• Other | 3 (1.2) |
Resource used to answer questions regarding ART (n = 140) |
• Referring physician | 81 (57.9) |
• Internet | 36 (25.7) |
• Patient information leaflet | 30 (21.4) |
• ART dispensing staff | 27 (19.3) |
• Other PLHIV | 13 (9.3) |
• PLHIV association | 8 (5.7) |
• Do nothing | 8 (5.7) |
• Other people (including family member, friends, etc.…) | 6 (4.3) |
Practice of self-medication (n = 111) |
• Antibiotics | 30 (27.0) |
• Antipyretics | 77 (69.4) |
• NSAID | 11 (9.9) |
• Antimalarial drugs | 4 (3.6) |
• Proton pump inhibitor / H2 antagonists | 5 (4.5) |
• Decoction and herbal medicine | 8 (7.2) |
• Other | 26 (23.4) |
One hundred fifty-one participants (64.5%) reported that they have already missed doses of ART rarely (
n = 139, 92.1%) or frequently (
n = 12, 7.9%). During the last 7 days before the interview, 15 participants (6.8%) reported missed doses of ART: 1 dose for 12 participants (5.1%), 2 doses for 1 participant (0.4%) and 3 doses or more for 3 participants (1.3%). The main reasons for missed doses of ART were detailed in Table
5. Among the 68 participants (45%) who declared other reasons for missed doses of ART, 27 participants declared that they were travelling and did not have enough pills or they forgot to bring their medication, 12 participants had missed doses because they did not have time to take their medication at the hospital, 6 participants reported missed doses related to stock-outs of ART at the hospital, 3 participants had missed doses because they drank alcohol and wanted to avoid side effects, 3 participants had missed doses because they felt depressed, 2 participants have stopped ART to avoid side effects and 1 participant reported reminder device problem. 9 (3.8%) participants reported having already increased or decreased the dose of their ART without any prescription, 7 (3%) participants reported having already thrown their ART away and 13 (5.6%) reported having already lost their ART. The different practices of the participants in the event of missed doses are described in Table
5. Among the participants interviewed, 94 (40.2%) declared that they never had questions about their ART. The resources used by the other 140 participants (59.8%) to answer questions about their ART are detailed in Table
5. Among the 234 participants, 111 (47.4%) reported using of self-medication and only 35 participants (33%) felt that they were aware of the risk of the practice of self-medication with ART. Among participants who reported self-medicating, 55 (45%) relied on their own knowledge, 28 (25.2%) on past prescription, 23 (20.7%) on the advice of other people (excluding medical staff and pharmacists), 13 (11.7%) on the advice of pharmacists, 5 (4.5%) on the patient information leaflet and 2 (1.8%) on internet for self-medication issues.