Pill-count Antiretroviral Therapy Adherence and its Contextual Determinants in a Semi-rural Ghanaian Municipality: A Mixed-methods Cross-sectional Study
Yaw Manu Boateng
Department of Pharmacy, Agona Government Hospital, Agona, Ghana.
Kwaku Gyamfi Oppong
Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Mustapha Bin Usman *
Department of Planning, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana and Nursing and Midwifery Training College, Tepa-Ashanti, Ghana.
Miriam Gborglah
Kumasi Centre for Collaborative Research, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Martha Masata Adeyiga
Department of Pharmacy, Tain District Hospital, Nsawkaw, Ghana.
Marshall Asare Owusu
Department of Pharmacy Practice, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
Yaa Gyaa Fynn
Regional Medical Stores, Sunyani, Ghana.
Paul Gyan
Department of Research, Health Facilities and Regulatory Agency, Accra, Ghana.
Richard Delali Agbeko Djochie
Department of Pharmacotherapeutics and Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University of Cape Coast, Cape Coast, Ghana.
Felicia Oppong
Maternal and Child Health Hospital, Kumasi, Ghana.
*Author to whom correspondence should be addressed.
Abstract
Background: Antiretroviral therapy (ART) adherence estimates in Ghana differ by setting and measurement method, and evidence from semi-rural municipal services using pill-count data remains limited.
Objective: To estimate ART adherence and examine individual, psychosocial, treatment-related and health-system factors among adults receiving HIV care at Ahafo-Ano North Municipal Hospital, Ghana, while contextualising quantitative findings with ART staff perspectives.
Methods: A facility-based mixed-methods cross-sectional study included 227 adults receiving ART. Adherence was assessed primarily by pill count, complemented by self-report and checked against pharmacy dispensing records, and classified at a ≥95% threshold. Chi-square tests and multivariable logistic regression assessed associated factors. Semi-structured interviews with three purposively selected ART staff provided complementary service-level context.
Results: Thirty-eight participants (16.7%) achieved ≥95% pill-count adherence. Most measured variables were not significantly associated with adherence; the manuscript separately reports an association between reasons for skipping doses and adherence (p < 0.001). In the multivariable model, reported social support from family or friends was associated with lower odds of adherence (AOR 0.28, 95% CI 0.09–0.90). Given the broad support measure and cross-sectional design, this result should not be interpreted causally. Staff described denial following diagnosis, transport and financial constraints, early adverse effects, stigma and limited follow-up capacity.
Conclusion: Fewer than one in five participants met the strict pill-count adherence threshold. Findings support context-sensitive adherence counselling, improved follow-up and transport-responsive service delivery, alongside longitudinal multisite research using standardised adherence and virological outcomes.
Keywords: Antiretroviral therapy adherence, HIV, Pill-count adherence, psychosocial factors, health system barriers