Adherence to Anti-retroviral Therapy among HIV-Positive Individuals in Ghana: The Role of Stress and Post Traumatic Stress Symptoms

Aims: To identify stress and post traumatic stress symptoms (PTSS) in HIV patients on Antiretroviral therapy (ART) and further assess the possible relationship between stress, PTSS, immune function and ART medication adherence.

Methods: After obtaining written informed consent, 150 HIV out-patients attending Pantang and Amasaman Hospitals in Accra, Ghana, were recruited for the study. Participants were interviewed using a questionnaire comprising of sections measuring demographic characteristics, perceived stress, post traumatic stress symptoms, and medication adherence. A measure of the immune function (CD4+) from individual’s health records was noted at the time of interview.

Results: Ninety four (62.7%) patients exhibited higher stress levels compared to the remaining 56(37.3%). The majority of participants (74%) showed PTSS at levels that met the optimal criteria indicative of post traumatic stress disorder (PTSD) and may have required clinical attention and management. Participants with high stress levels were 84% less likely to be adherent to their antiretroviral medication compared to those with lower levels of stress [OR=0.16 (0.050–0.512), P<0.0001]. Patients who showed evidence of stress were approximately four times more likely to develop PTSD compared to non-stressed patients [OR=3.898 (1.428–10.635), P=0.007]. The experience of side effects did not influence adherence [OR = 0.536 (0.224–1.285), P = 0.155]. On the other hand, stress significantly related with adherence when side effects were present [OR=0.648 (0.252– 1.662), P=0.002]. The PTSD importantly associated with adherence to ART with approximately 42% less odds of attaining optimal adherence by participants with PTSD compared to non-PTSD patients [OR=0.576 (0.189–1.751), P=0.017].

Conclusion: HIV patients on ART need to be screened for stress, PTSS and PTSD in order to benefit from psychological support and therapy. This activity can significantly enhance medication adherence as well as impact positively on the general health outcomes of HIV patients on ART.