Abstract / Summary
Background and objectives: Differing models of HIV service delivery may influence medication adherence. This study compared ART adherence between adults receiving combined home-based and clinic care and adults receiving clinic care alone at a tertiary hospital in Kano, Nigeria. Methods: A comparative cross-sectional study was conducted among 546 adults receiving ART for at least six months: 273 received combined home-based and clinic care and 273 received clinic care alone. Adherence was measured using the Morisky Medication Adherence Scale and classified as high/medium or low. Group differences were assessed using chi-square testing. Results: High/medium adherence was reported by 224 (82.1%) clients in the combined-care group and 198 (71.7%) in the clinic-only group. Low adherence was reported by 49 (17.9%) and 76 (27.8%), respectively. The difference was statistically significant (χ²=7.56, p=0.01). The combined-care group also reported more frequent difficulty remembering medication on individual MMAS items, despite having a higher overall proportion classified as adherent. The care groups differed significantly in some background and treatment characteristics, including educational level, daily frequency of ARV use and duration on ART. Conclusions: ART adherence differed significantly between the two service-delivery groups, with a higher proportion classified as adherent among clients receiving combined home-based and clinic care. Because the study was observational and the groups were not equivalent at baseline, the difference should be interpreted as an association rather than a causal effect.