Evaluating the Effectiveness of Interventions to Improve ART Adherence in Resource-Limited Ghanaian Settings
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Abstract
Background: Sustained adherence to antiretroviral therapy (ART) is critical for viral suppression and improved survival among people living with HIV (PLHIV). In resource-limited settings such as rural Ghana, programmatic interventions aim to address structural and behavioural barriers to adherence, yet their effectiveness requires empirical evaluation.
Objective: To assess the association between exposure to selected ART adherence interventions and adherence levels among PLHIV in a rural Ghanaian municipality.
Methods: A cross-sectional survey was conducted among 602 PLHIV in Wassa Amenfi West Municipality who had been on ART for at least six months. Data were collected using a structured interviewer-administered questionnaire and verified with pharmacy refill records. Interventions assessed included individual adherence counselling, peer support groups, home visits by healthcare workers, and community sensitisation activities. Chi-square tests were used to examine associations between intervention exposure and adherence, with significance set at p < 0.05.
Results: Adherence counselling was the most widely accessed intervention (85.0%), followed by community sensitisation (56.8%), peer support groups (39.2%), and home visits (32.9%). All four interventions were significantly associated with higher adherence rates: counselling (χ² = 18.92, p < 0.001), peer support (χ² = 9.52, p = 0.002), home visits (χ² = 12.67, p < 0.001), and community sensitisation (χ² = 14.21, p < 0.001). Participants receiving home visits achieved the highest relative adherence gain (89.9% vs. 80.2%).
Conclusion: Multi-component interventions, especially those involving personalised contact such as home visits and peer group engagement, are effective in promoting ART adherence in rural Ghana. Expanding the reach of these high-impact but underutilised strategies, alongside maintaining established services like counselling, could accelerate progress toward national HIV treatment targets.
Keywords: ART adherence, interventions, HIV/AIDS, home visits, peer support, Ghana, resource-limited settings
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