Research Article

Clinical Immunology & Research

Explaining Adherence to HAART among Patients Living with HIV/AIDS in

Nigeria: Behavioral Theory Analysis
Abayomi Joseph Afe1*, Olanrewaju Motunrayo2 and Gbadebo O.Ogungbade3

*
Correspondence:
Equitable Health Access Initiative, Marina, Lagos, Nigeria.
1
Abayomi Joseph Afe, Equitable Health Access Initiative, P.O.Box
10047, GPO, Marina, Lagos, Nigeria, E-mail: abayomiafe@yahoo.
Babcock University, Marina, Lagos, Nigeria.
2
com.
Adeleke University, Marina, Lagos, Nigeria.
3
Received: 01 November 2017; Accepted: 24 November 2017

Citation: Joseph Afe A, Motunrayo O, Gbadebo O.Ogungbade. Explaining Adherence to HAART among Patients Living with HIV/
AIDS in Nigeria: Behavioral Theory Analysis . Clin Immunol Res. 2017; 1(1): 1-8.

ABSTRACT
Background: The number of Nigerians infected with the HIV infection in 2016 was about 3million, which was the
second highest burden globally and accounted for 9% of the worldwide burden of the HIV/AIDS. The country ART
programme which commenced in 2001 had adult coverage of 48.3% in 2014. Effectiveness of the antiretroviral
drug regimens requires a very good level of adherence (95%) to suppress viral replication. Despite all the strategies
to address the adherence barriers to HAART, the problems of poor adherence are ever-present. Factors determining
adherence to HAART drug regimens have been studied in various population but little is known on this subject among
PLHIV in Nigeria. Identifying and overcoming the factors that reduce adherence to combination antiretroviral
agents is of utmost importance for prolonged viral load suppression. Very few of the strategies developed to mitigate
the challenges of non-adherence were based on the theories of health behavior. However, behavioural theories, if
adopted, could assist in the development of more effective interventions to improve treatment adherence. This cross-
sectional study was conducted to explain the dynamics of HAART adherence among Nigerians living with HIV/
AIDS; using behaviour change theories such as the Theory of Planned Behavior (TPB) and Health Belief Model
(HBM).

Methods: This was a questionnaire-based study using closed ended-questionnaires administered by the on the 225
participants.

Findings: TPB model factors such as the ability to set realistic goals and objectives with respect to medication
adherence and meet such goals did not have any significant association with adherence (P 0.001) among the
PLHIV. Likewise other TPB factors like determination and self-discipline to adhere to medications (HAART) do not
have statistical association with HAART adherence. On the other hand, Health Believe Model (HBM) components
such as the belief that adherence to HAART improves HIV patent's health condition (P=0.004),adherence to HIV
medication is feasible in the Nigerian context (P=0.00), refusal to adhere to HAART is a serious health risk for the
HIV patient (P=0.00), non-adherence to HAART is life threatening for the HIV patient(P=0.00), non-adherence to
HAART can lead to AIDS faster (P=0.00), and the consequences of non-adherence to HAART are severe (P=0.00)
all show significant statistical association with HAART adherence .Also significant statistical association was
found between HAART adherence and other health believes like adherence to HAART is beneficial (P=0.00).

Conclusion: Unlike the theory of planned behaviour, health believes Model was most suited to explaining or
predicting patterns of HAART adherence behaviour among Nigerians PLHIV. However, for the model to be most
effective it would need to be integrated with other models that take into account the environmental context and
recommend strategies for change.

Clin Immunol Res, 2017 Volume 1 | Issue 1 | 1 of 8

Keywords Other complications are increased health care costs, emergence of
HIV, HBV, PMTCT, vertical transmission, ART (Antiretroviral drug resistance and limited future treatment options.
therapy).
In many studies, perfect adherence to ART (95%) has led to
Introduction dramatic reductions in viral load to undetectable levels, compared
The population of Nigerians living with the HIV infection was to smaller viral load reductions seen when doses were missed
about 3 million in 2016,which was the second highest in the world [10]. Small viral load reductions can lead to increased risk of
after south Africa and represent 9% of the worldwide burden of the viral mutation and drug resistance. Several estimates of adherence
HIV/AIDS [1,2]. Nigeria accounted for about one third of all new level to antiretroviral therapy were reported to fall below the 95%
paediatric HIV in the 21 HIV priority countries in sub-Saharan adherence recommended to maintain long-term viral suppression
Africa: the largest number from any country [3]. It also had the [11-13].
highest population of children acquiring HIV infection; about 60,
000 in 2012 and this figure has remained largely the same since Highly Active Antiretroviral Therapy (HAART)
2009 [4]. This is a combination of atleast three antiretroviral drugs from
at least two different classes of ARV which act on at least two
Nigeria has generalized HIV epidemic with wide differences different points in the HIV life cycle. Typically, a backbone of
in the prevalence across the country. The HIV prevalence has an NNRTI or a PI can be combined with 2 NRTIs. The choice of
declined over the years, from 5.8 percent in 2001 to 4.6 percent in drugs to use in each class is based on availability, accessibility,
2008, 4.1% in 2010 and 3.0% in 2014 [5]. Incidence of new HIV affordability, efficacy and ease of administration of antiretroviral
infections in Nigeria are driven by factors such as low perceptions drugs. Monotherapy or dual therapy is not recommended for
of personal HIV risk, multiple sexual partnerships, transactional treatment because of the increased risks of development of drug
and intra-generational sex, poor treatment services for sexually resistance. Scientists have observed that multiple factors influenced
transmitted infections (STIs), and inadequate access to quality adherence to medication among patients with chronic diseases in
health care services. Other contributing factors include gender general [14]. Poor treatment adherence remains a challenge to
inequalities and inequities, poverty and HIV/AIDS stigma and the control of many infectious diseases such as tuberculosis and
discrimination [6]. human immunodeficiency virus (HIV) infection.

The Nigerian national ART programme started in 2001 with 25 Non-adherence is multifactorial and differs between patients.
tertiary hospitals and targeted 10,000 adults and 5,000 children. Successful long-term treatment of HIV/AIDS requires at least
However, following the 3 by 5 WHO initiative, the target was 95% adherence to the antiretroviral therapy (HAART) required for
reviewed to achieve universal access to ART by 2010. As at viral suppression required to keep people living with HIV/AIDS
2014, ART coverage among children consistently remained low (PLHIV) in good health and prevent emergence of drug-resistant
when compared to adults. Generally, there is an increase in ART HIV variants that could lead to regimen failure and limit options
coverage from 10.2% in 2010 to 20.7% in 2014 for children under for future therapy [15-17].
15 years. The adult coverage showed a progressive increase from
27.6% in 2010 to 48.3% in 2014. As at 2014, the National ART Despite all the strategies to address the adherence barriers to
program covered 747,382 (44%) out of the estimated 1,670,016 prescribed HAART drug regimens to manage HIV/AIDS, the
persons (adults and children) estimated to need ART by December, problems of inadequate observance are ever-present [18]. Among
2014. This shows a very poor achievement when compared with people living with HIV, it is almost impossible to predict which of
the national target sustainable scale-up of ART coverage [6,7]. them will best adhere to antiretroviral therapy (ART) medication
as preconceived ideas about who will be adhering and who will
The use of antiretroviral therapy (ART) has allowed people infected not are often wrong. Factors determining adherence to ARV drug
with HIV infection to live longer, healthier lives, slowing disease regimens have [3], been studied in various population but little
progression and preventing opportunistic diseases. Generally, is known on this subject among people living with HIV/AIDS
most medications used in treating chronic disease conditions are in Nigeria. Identifying and overcoming the factors that reduce
less effective without perfect adherence. Common estimates of adherence to combination antiretroviral agents is of utmost
drug adherence in most chronic illness [8], are from 20% to 80%, importance for prolonged viral load suppression. Very few of the
averaging 50%, and decreasing over the duration of the treatment many interventions developed to address the challenges of non-
[9]. Effectiveness of the antiretroviral drug regimens requires adherence are based on behaviour theories. These theories of health
at least a very good level of adherence. This is so because good behaviour can be used to develop more effective interventions to
adherence ensures that the blood therapeutic level of the ARV is promote ART adherence and can be used to assess the possibility
maintained to suppress viral replication. The consequences of poor of extending other interventions to different health issues and
adherence include inadequate viral suppression leading to greater settings. This cross-sectional study aimed to use behavior change
probability of transmission, immunologic and clinical failure thus theories applicable to long-term treatment adherence, such as
increasing the susceptibility to opportunistic infections, disease the Theory of Planned Behavior (TPB) and Health Belief Model
progression which increase HIV-related mortality and morbidity. (HBM) as theoretical framework and a self-addressed tool to
Clin Immunol Res, 2017 Volume 1 | Issue 1 | 2 of 8
explain the dynamics of HAART adherence among Nigerians making process that does not can change over time.
living with HIV/AIDS; assess the evidence for their effectiveness • The perceived behavioral control component of this theory
of the theories in predicting behavior change; and examine the doesn't say anything about actual control over behavior.
implications of these findings for developing strategies to improve • The theory does not address the time frame between "intent"
HIV/AIDS medication adherence. and "behavioral action".

The Theory of Planned Behaviour

The theory of planned behaviour (TPB) is a very commonly used
behaviour theory. It adopts a cognitive method of explaining
behaviour which centres on individuals’ attitudes and beliefs [19].
TPB started as the theory of reasoned action in 1980.The theory of
reasoned action posited intention as the best predictor of behaviour.
This theory was used to predict an individual's intention to engage
in a behavior at a specific time and place.

Though intention is an outcome of the combination of attitudes

towards a behaviour. TPB is composed of six constructs which
Figure 1: The Theory of Planned Behaviour (adapted from Munro et al.
collectively represent a person's control over a behavior.
2007).
• Attitudes - This is the degree to which a person has a favorable
or unfavorable evaluation of the behavior of interest. It entails The Health Belief Model
a consideration of the outcomes of performing the behavior. The Health Belief Model (HBM) was developed in the early
• Behavioural intention – These are the motivational factors 1950s to comprehend the failure of some people to accept disease
that influence a given behaviour; the stronger the intention to prevention strategies or screening tests for the early detection of
perform the behavior, the more likely the behaviour will be disease.
performed.
• Subjective norms - This refers to a person's beliefs about Other uses of HBM include understanding of patients' responses
whether peers and people of importance to the person think to symptoms and compliance with medical treatments .The model
he or she should engage in the behavior and their inclination postulates that behaviour is determined by beliefs about threats to
to comply with these. an individual's wellbeing and the effectiveness and outcomes of
• Social norms – This refers to the customary codes of behavior particular actions or behaviuor [8,22-24]. In other words, the model
in a group of people or larger cultural context and could be suggests that belief in a personal threat of an illness or disease
normative, or standard. together with belief in the effectiveness of the recommended
• Perceived power – This is the perceived presence of factors health behavior or action will predict the likelihood of adoption
that may facilitate or hinder performance of a behavior. of the behaviour. Conversely, when a person perceives a threat is
Perceived power determines a person's perceived behavioral not serious or himself as unsusceptible to it, he is unlikely to adopt
control over these factors. mitigating behaviours. Same effect is seen with perceived low
• Perceived behavioral control –Also known as self-efficacy. It benefits and high costs of the behavior.
is the perception of the ease or difficulty of performing the
behavior of interest. This perception differs across situations There are six constructs of the HBM; the first four were the original
and actions and can lead to a person having different tenets while the last two were recent additions.
perceptions of behavioral control in different situations. This
construct when added to the theory of reasoned action caused • Perceived susceptibility - This is the subjective perception
its transformation to the theory of planned behavior [20,21]. of the risk of acquiring an illness or disease. There is wide
variation in this perception of personal vulnerability.
Limitations of the Theory of Planned Behaviour • Perceived severity - This refers to a person's feelings of the
• It presumes the availability of opportunities and resources danger or complications of contracting an illness or disease.
needed for a successful performance of the desired behaviour, This perception varies with different persons and is influenced
regardless of the intention. by the medical consequences (e.g., death, disability) and
• It does not take into account other variables that influence social consequences (e.g., family life, social relationships)
behavioural intention and motivation, such as fear, threat, associated with the diseases.
mood, or past experience. • Perceived benefits - This refers to a person's perception of
• Likewise, environmental or economic factors that may the effectiveness of various measures available to reduce the
influence a person's intention to perform behaviour are not risks of illness to cure disease. The choice of preventive or
taken into consideration by this theory curative measures a person adopts depends on consideration
• It presumes that behavior is the result of a linear decision- and evaluation of both perceived susceptibility and perceived
Clin Immunol Res, 2017 Volume 1 | Issue 1 | 3 of 8
 benefit of such actions, so that health action perceived as used to select the sample size of into 225 HIV infected persons.
beneficial are readily adopted.
• Perceived barriers - This refers to having a feeling of presence Study Instrument Design: Interviewer administered structured
of obstacles to performing a recommended health action. questionnaire. The high reliability and validity of the questionnaire
This feeling varies widely with people and leads to a cost/ content was evaluated in a pilot study and by experts opinions.
benefit analysis in which the person weighs the effectiveness
of the actions against the perceptions that it may be expensive, Inclusion Criteria: To be eligible to participate in this survey,
may have side effects, may be painful, time-consuming, or potential participants were required to:
inconvenient. 1. HIV infected patients enrolled in ART clinics
• Cue to action - This is the stimulus needed to initiate the 2. Adults not less than 18 years of age
decision-making process to accept a recommended health 3. Provide voluntary informed consent
action. These cues can be internal (e.g., chest pains, wheezing,
etc.) or external (e.g., advice from others, illness of family Exclusion criteria: Participation was restricted from individuals
member, newspaper article, etc.). These cues influence the who were:
perception of threat and can cause a change in behaviour or a. Not mentally capable of providing response
maintain. b. Previously sampled by the same questionnaire
• Self-efficacy - This defines the level of a person's confidence
in his or her ability to successfully perform a behavior. It Data Analysis
is associated with many behavioral theories as it directly Analysis of the data collected in this study was done with statistical
determines whether a person performs the desired behavior. package for the social sciences (SPSS) for windows version 20.0
• Both perceived susceptibility also known as perceived software (SPSS Inc; Chicago, IL, USA). Tables of frequency
vulnerability and perceived severity are combined as perceived counts were generated for all variables and statistical test of
threat which form the core of the HBM as it is linked to a significance was performed with chi-square test. Significance was
person's ‘readiness' to take action. The self-efficacy is a key fixed at P<0.05.
component of the model.
Study Weaknesses
Some limitations of Health Belief Model include the following: • The study findings are representative of those who complete
• It does not consider individual’s attitudes, beliefs, or other the survey and may be difficult to extend to the Nigeria
personal determinants that dictate acceptance of a health resident as a whole, being a heterogeneous population.
behavior. • Response bias.
• It disregards habitual behaviors such as smoking which may • Study incapable of estimating any causal association.
influence decision-making process to accept a recommended • Selection bias as persons who refused to participate in the
action survey may have differed opinions from respondents with
• Non-health related behaviors such as social acceptability are respect to Adherence to HAART.
not factor into this model
• Environmental or economic factors that may prohibit or Information and selective bias are potential limitations of this
promote the recommended action are not considered. study.
• It assumes there is an access to equal amounts of information
on the illness or disease. Study strength
• It presumes that cues to action are prevalent in encouraging • The use of theories of health behaviour to analyse adherence
people to act and that "health" actions are the main goal in the to HAART in Nigeria settings is a novel idea.
decision-making process. • The ability to identify HAART adherence risk determinants/
factors in Nigerian resident sample, which have neither been
Methods studied nor documented as far as we know.
Study Population: Persons living with HIV/AIDS infection.
Ethical consideration: Ethical approval obtained with protocol
Sampling areas: Adult ART clinics at public health facilities in number (ERC/2016/03/02/10B).
Ondo and Ekiti southwestern states.
Results
Sample and Sampling Technique: Convenient sampling. Section 3.1: Sociodemographic Characteristics of Respondents
Table 3.1 showed that there were more female (181, 80.40%) than
Sample Size: The sample size of 225 was calculated using online male (19.6%) living with HIV infection among the respondents.
raosoft formula: Sample size n = N x/((N-1)E2 + x)) (17). More than half, (139, 61.7%), of the respondents were married
while less than a fifth (66; 29%) were singles About 96% of the
Sampling Method: Non-probability convenient sampling was respondents were literate with 2.7% illiteracy rate. Employment
Clin Immunol Res, 2017 Volume 1 | Issue 1 | 4 of 8
rate was also more than half (59%) while the unemployed rate was HAART Adherence
about 31.6%. Most (202, 89.8%) were of the Christianity faith. Total
No % Yes %
I can set realistic Don’t Know 2 5% 10 5% 12
Gender Frequency Percent goals/objectives for No 1 3% 9 5% 10
Female 181 80.4 HAART adherence
(P=0.263) Yes 37 93% 166 90% 203
Male 44 19.6
Total 40 100% 185 100% 225
Total 225 100.0
I can meet set Yes % No %
Marital status Frequency Percent realistic goals/ Don’t Know 1 2.5% 12 6% 13
Co-Habiting 3 1.3 objectives for
HAART Adherence No 1 2.5% 7 4% 8
Divorced 4 1.8
(P=0.994) Yes 38 95% 166 90% 204
Married 136 60.4
Total 40 100 185 100% 225
Separated 4 1.8
HAART Adherence
Single 66 29.3 Total
No % Yes %
Widowed 12 5.3
Not at all
Total 225 100.0 0 0% 1 1% 1
determined
Highest educational level Frequency Percent Not so
0 0% 3 2% 3
No Formal Education 6 2.7 determined
Primary 36 16.0 How determined No Response 8 19% 21 11% 29
are you to adhere
Secondary School 150 66.7 Determined 10 24% 70 38% 80
medications ?
Bachelor/HND/OND 23 10.2 (P=0.953) I Don’t Know 2 5% 4 2% 6
Postgraduate 10 4.4 Not so
0 0% 3 2% 3
determined
Total 225 100.0
Very
Employment Status Frequency Percent 22 52% 81 44% 103
Determined
Employed 133.0 59.1 Total 42 100% 183 100% 225
Retired 4 1.8 HAART Adherence Total
Student 17 7.6 No % Yes %
Unemployed 71 31.6 Don’t Know 2 5% 8 4% 10
Total 225 100.0 Agree 14 35% 89 48% 103
I have self-
Religion Frequency Percent discipline to Disagree 0 0% 6 3% 6
Christianity 202 89.8 adhere to HAART Don’t Know 2 5% 12 6% 14
(P=0.655)
Muslim 23 10.2 Strongly
22 55% 70 38% 92
Total 225 100.0 Agree
Table 1: Sociodemographic Characteristics of Respondents. Total 40 100% 185 100% 225
Table 2: Explaining Adherence among PLHIV Using Theory of Planned
Explaining Adherence with Behavioural Theory (TPB)
Behaviour.
Of the 225 respondents, about 93% of those who do not adhere to
HAART and 90% of those who adhere to HAART can set realistic Explaining adherence using Health Believe Model (HBM)
goals/objectives for HAART adherence. Thus ability to set realistic About 58% and 46% of patients who were non- adherent to
goals and objectives was not associated with adherence to HAART HAART and HAART-adherent respectively strongly believed that
(P=0.263). Also about 94% and 90% of PLHIV with non-adherent adherence to HAART improves HIV patent’s health condition
and adherent history respectively can meet set realistic goals/ (P=0.004). While 66% of PLHIV who were HAART adherent
objectives for HAART adherence (P=0.994). Implying that ability believed that adherence to HIV medication is feasible in the
to meet set realistic goals/objectives for HAART adherence had Nigerian context only 48% of those non-adherent strongly held
no effect on the actual adherence. About half (52%) of the patients this believe too (P=0.00). About 68% of adherent patients and 63%
who are non-adherent have determinations to adhere while only of non-adherent patients agreed and strongly agreed respectively
44% of those who are adherent claimed to have the determinations that refusal to adhere to HAART is a serious health risk for the
to adhere. More patients (55%) who are not adherent to HAART HIV patient (P=0.00). About 46% and 50% of PLHIV who were
had self-discipline to adhere to HAART while only 38% of those HAART adherent and HAART non-adherent agreed and strongly
adherent to HAART had the self-discipline to adhere (P=0.655). agreed respectively that non-adherence to HAART was life
Inferring that having self-discipline to adhere to HAART is not threatening for the HIV patient (P=0.00). About 70% of PLHIV
associated with HAART adherence. who were adherent to HAART agreed that non-adherence to
Clin Immunol Res, 2017 Volume 1 | Issue 1 | 5 of 8
HAART can lead to AIDS faster while only 35% of those who were Don’t Know 7 18% 11 6% 18
non-adherent agreed with this statement (P=0.00). About 65% of Agree 13 33% 120 65% 133
PLHIV who were HAART adherent agree that the consequences P=.000 Disagree 3 8% 6 3% 9
of non-adherence to HAART were severe while only 40% of
Strongly Agree 16 40% 45 24% 61
those not HAART adherent strongly held such believe (P=0.00).
Strongly Disagree 1 3% 3 2% 4
Almost 59% of HAART-adherent PLHIV agreed that adherence to
Total 40 100 185 100 225
HAART was beneficial while about 45% of those non-adherent to
Adherence to HAART
HAART strongly agreed that adherence to HAART was beneficial Adherence to HAART is beneficial Total
No % Yes %
(P=0.00).
Don’t Know 9 33% 7 4% 11

Adherence to HART Agree 13 33% 110 59% 123

Believe that adherence to HAART
Total Disagree 0 0% 1 1% 1
improves HIV patent’s health condition No % Yes %
Don’t Know 4 10% 8 4% 12 Strongly Agree 18 45% 65 35% 83

Disagree 2 5% 4 2% 6 Strongly Disagree 0 0% 2 1% 2

P=0.004 Agree 10 25% 86 46% 96 Total 40 111 185 100 225

Strongly Agree 23 58% 85 46% 108 Table 3: Explaining Adherence Among PLHIV Using Health Believe
Model (HBM).
Strongly Disagree 1 3% 2 1% 3
Total 40 100 185 100 225 Discussion
Adherence to HIV medication is Adherence to HAART All the 225 questionnaires administered were completely answered
feasible in the Nigerian context No % Yes % Total with the data cleaned and retrieved for analysis. There were more
Agree 11 28% 122 66% 133 respondents who were female, married and had college education as
Disagree 0 0% 1 1% 1 the highest attained level of education. Such similar findings have
P=0.000 Don’t Know 12 30% 10 5% 22
been reported from other works done on adherence in the region
[25]. Some African studies carried out among adult HIV patients in
Strongly Agree 16 40% 51 28% 67
clinic settings also had higher ratio of female to male respondents
Strongly Disagree 1 3% 1 1% 2
[26,27]. More than fifty percent of the respondents were employed
Total 40 100 185 100 225 and most were Christians. This is contrary to national demographic
Refusal to adhere to HAART is a Adherence to HAAR T survey which showed almost equal proportions of Christian and
serious health risk for the HIV patient No % Yes % Total Muslims in the country and lower proportions of Nigerians with
Don’t Know 5 13% 6 3% 11 secondary and tertiary education [28].
Agree 8 20% 125 68% 133
P=0.000 Disagree 1 3% 5 3% 6
Using the theory of planned behaviour (TPB) to explain HAART
adherence among the clients, it was found that TPB model
Strongly Agree 25 63% 49 26% 74
factors such as the ability to set realistic goals and objectives
Strongly Disagree 1 3% 0 0% 1
with respect to medication adherence and meet such goals do not
Total 40 100 185 100 225 have any significant association with adherence (P 0.001) among
Non-adherence to HAART is life Adherence to HAART the PLHIV. Likewise other TPB factors like determination and
threatening for the HIV patient No % Yes % Total self-discipline to adhere to medications (HAART) do not have
Dont Know 8 20% 26 14% 34 statistical association with HAART adherence.
Agree 11 28% 86 46% 97
P=0.000 Disagree 0 0% 4 2% 4 On the other hand, Health Believe Model (HBM) elements such as
the belief that adherence to HAART improves HIV patent's health
Strongly Agree 20 50% 67 36% 87
condition (P=0.004), adherence to HIV medication is feasible in
Strongly Disagree 1 3% 2 1% 3
the Nigerian context (P=0.00), refusal to adhere to HAART is a
Total 40 100 185 100 225 serious health risk for the HIV patient (P=0.00), non-adherence
Non-adherence to HAART can lead to Adherence to HAART to HAART is life threatening for the HIV patient (P=0.00), non-
AIDS faster No % Yes % Total adherence to HAART can lead to AIDS faster (P=0.00), and the
Don’t Know 21 53% 49 26% 70 consequences of non-adherence to HAART are severe (P=0.00)
P=0.000 False 5 13% 6 3% 11 all show significant association with HAART adherence .Also
True 14 35% 130 70% 144 significant statistical association was found between HAART
adherence and other health believes like adherence to HAART is
Total 40 100 185 100 225
beneficial (P=0.00).
Consequences of non-adherence to Adherence to HAART
HAART are severe No % Yes % Total
The theory of planned behaviour which has been used widely
Clin Immunol Res, 2017 Volume 1 | Issue 1 | 6 of 8
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