CHAPTER ONE INTRODUCTION

• Background to the Study

In the last decades, scholars, policy makers and health practitioners have debated the causes, effects and solutions to the prevalence of Human Immune Virus (HIV) infection menace and its opportunistic deaths and ailment. Report from United Nations AIDS gap indicates that, over 35 million people around the world may be living with HIV/AIDS and out of this, about 19 million do not know if they have the disease (UNAIDS, 2014). The gap report further states that, just 10 nations in sub-Saharan African (SSA) contribute 56% of the total number of people with the virus. The Ghana AIDS Commission, (2013), report that, as at 2013, 260,000 Ghanaian were living with Human Immune Virus.

The surge in global HIV/AIDS statistics leaves many scholars and practitioners wondering how the spread can be controlled and contained at the patient level. Kranser et al. (2011) explain that, an improvement in HIV care management strategies is crucial to ensure patients retention and adherence to Antiretroviral Therapy for people living with the disease (Kranser, et al., 2011).

Antiretroviral Therapy reduces overall infection, incidence, and related deaths and improves quality of life patients living with the virus. For decades, issues of retention and adherence to ART, even though have barriers to full compliance, have featured significantly in HIV patient care management efficiency architecture and studies. Adherence and retention in HIV care is described as a continuous engagement with medical care at a healthcare facility after initial entry

into the system. It is the ability of the patient to fulfill at least two clinic visits during a calendar year spaced at least 2-6 months. (Bezabhe, Chalmers, Bereznicki…Kassie et al., 2014).

In Sub-Saharan Africa about 8 million HIV positive patients were on ART between 2004 and 2011 (Kranser et al., 2011). Jahn et al. (2008) noted that, access to ART has contributed to a reduction in HIV-associated morbidity and mortality in Sub-Saharan region. In Ghana also, some significant level of successes has been recorded with regards to ART coverage of 54% (Unit, 2001). In 2016, Ghana adopted the 2020 UNAIDS/WHO 90-90-90 target in a bid to end HIV epidemic by 2030. World Health Organisation (2017) explains that, Retention in HIV care and Adherence to ART, though are different, share similar barriers and facilitators (WHO, 2017).

Ghana Demographic and Health Service (GDHS 2014) reports that, “Ghana is classified as having a generalized HIV epidemic where HIV prevalence in the country has remained on average around 2% in adults 15-49 years”. With Antiretroviral therapy coverage for Ghana standing at 54% (Unit, 2001), the researcher believes that, the barriers and facilitators to Retention in HIV care and Adherence to ART must be identified in order to help scale up the number of HIV positive persons retained in care and adhere to antiretroviral therapy.

Emerging literature indicates that, negative stigma, depression, lack of awareness of importance of care, depression, location and poor access to transportation are likely to hinder the retention to HIV care and adherence to ART (Abdulai, 2016). On the other hand, issues such as friendly client-provider relationship and reminders of clinic days have also been identified as factors that facilitate retention in HIV care and adherence to ART. Other emerging studies have begun to analyse these barriers and facilitators from patients and environmental perspective, thus creating wider avenue for more investigation (Abuogi et al,2016)..

Adherence to a medication is a dynamic behaviour influenced by many factors. Studies in resource-limited settings show that “major facilitators of ART adherence encompass social support, positive treatment outcomes, and life-long projects. Factors such as access to health facilities, transport costs, and fear of stigma and discrimination are recognized barriers to adherence with ART” (Bezabhe. et al., 2014). This study seeks to explore from the perspective of HIV patients, the barriers to Retention in HIV care as well as Adherence to ART. The studies seeks to provide innovative HIV care management solutions to minimize the risk of opportunistic infection, reduces the risk of HIV transmission and reduce HIV-associated morbidity and mortality in Ghana.

                        Problem Statement

The World Health Organization has described HIV patient retention in care as an important indicator for efficiency of any HIV management program. Despite the effort of global health organisations to improve patient retention in care, the trend and statistics in Sub-Saharan Africa is falling. The Globally average retention rate at 12 months after initiation of ART is 81%. A meta-analysis showed that in Sub-Saharan Africa, the retention rate after 12 months of starting ART was 77% below the global threshold. A study done by Korle (2016) discovered that the retention rate in HIV care at the International health Care Centre in Accra, Ghana is 55% which is also below the global and African levels. It has been 2 years since Ghana adopted the 2020 UNADS/WHO 90-90-90 targets.

However, the country is performing at 57%, 39% and 64% with regards to the first, second and third 90 respectively compared to the worldwide performance of 75%, 79% and 81% respectively (UNAIDS,2017). Suboptimal adherence and retention in care can lead to viral

resistance to first line ART. This poses a risk in countries where there may be limited supply of second and third line antiretroviral drugs. This may result in poor viral suppression which increases the risk of HIV transmission, increases the risk of opportunistic infection and decreases the survival rate of persons living with HIV (WHO, 2017).  This subsequently derails the national as well as global efforts at achieving the 909090 targets by 2020 (UNAIDS 2017).

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