1.0 Introduction

1.1 Background information

The HIV/AIDS epidemic has grown significantly over the past 30 years, from a relatively small problem in the 1980s to one of the major causes of mortality and burden over the past ten years (1). Approximately 38.4 million people were living with HIV at the end of 2021 with 1.5 million people becoming newly infected with HIV globally (2). In Africa 25.6 million people were living with HIV in 2021, of which 88% knew their status 78% were on treatment and 72% were virally supressed (3). In Tanzania, HIV is one of the major public health concerns, the prevalence is estimated to be 5.1% which approximately 1.5 million people are living with HIV (4) In collaboration with its development and implementing partners, The Ministry of Health of Tanzania has been striving to reduce the burden of disease. The HIV care and treatment plan was launched in October 2004 aiming at providing 440,000 AIDS patients with antiretroviral drugs and track disease progression in 1.2 million HIV positive individuals by the end of 2008 (5). After four years of implementing HIV and care treatment, there was a number of successes in terms of coverage, number of patients who have access to treatments, staff capacity development and the infrastructure of the health system. scaling up of ART services has decreased number of new infections by 13% resulting in decrease in mortality rate of 50% between 2010 and 2018 (4). Non-adherence with antiretroviral therapy can lead to the establishment of drug resistant strains of the HIV virus and treatment failure. Although it is not a new problem or one that just affects people with HIV/AIDS, non-adherence to therapy has recently received more attention because of the complex combination treatment regimens that are being recommended (6). Evidence shows that adherence rates between 70% and 89% are significantly associated with viral rebound and the development of drug resistance (7). Numerous factors including sociodemographic, psychological, socioeconomic, sociobehavioural and environmental ones have been associated to non-adherence to antiretroviral therapy (4). In resource limited setting, levels of self-reported adherence range between 78% and 96% and in some higher countries, they range from 44% to 66%. Despite these high adherence levels, there are barriers to adherence levels that vary according to local circumstances (8). Since, adherence to antiretroviral medication regimens, is a paramount in the management of HIV, we aim to assess factors leading to non-adherence of antiretroviral drugs among people living with HIV/AIDS attending HIV/AIDS clinic at Bugando medical centre.

1.2 Problem Statement

The lives of people living with HIV have been transformed by the development of highly efficient antiretroviral therapy. However effective therapy necessitates taking daily pills for the rest of one’s life, which can present adherence related problems that have an impact on morbidity and mortality (9). A study done in Dar es salaam showed that adherence rate was 85% (6). A study done on Tanzania, Pwani on factors leading to non-adherence showed that failure to disclosure HIV positive, alcohol, depression and lack of support were associated with non-adherent to ART (10). Since adherence is the strongest predictor of successful treatment outcome, a clear understanding of the factors leading to non-adherence is very crucial in order to develop measure to support and sustain adherence in care of HIV patients. Since data are limited on factors for non-adherent among patients attending at Bugando medical centre, this made this study more interested for wellbeing of the community living with HIV /AIDS.

1.3 Rationale of the Study

Findings from this study will be a way to understand the barrier to non-adherence among HIV patients, these will help to tackle the barriers leading to non-adherence. Findings will give emphasis on areas to give education on the importance of strict adherence to the ART. It will also help patients and families to recognize and overcome the barriers leading to nonadherence.

1.4 Research Question
What are the factors leading to non-adherence of antiretroviral drugs among people living with HIV/AIDS attending HIV/AIDS clinic at Bugando medical centre?

1.5 Research Objectives 1.5.1 Broad Objectives
Assessment of prevalence and factors leading to non-adherence of antiretroviral drugs among people living with HIV/AIDS attending HIV/AIDS clinic at Bugando medical centre.

1.5.2 Specific Objectives

1. Prevalence of non-adherence of antiretroviral drugs among people living with
HIV/AIDS attending HIV/AIDS clinic at Bugando medical centre.
2. Assessment of factors leading to non-adherence of antiretroviral drugs among people
living with HIV/AIDS attending HIV/AIDS clinic at Bugando medical centre