Literacy, education and adherence to antiretroviral therapy in The Gambia

Abstract

We examined the relationship of patients’ literacy and education to antiretroviral therapy (ART) adherence in an urban treatment centre in The Gambia. Information on education and literacy systematically collected before ART initiation was compared against selected adherence outcomes.

Formally educated patients were significantly more likely to achieve virological suppression at both six and 12 months (87% vs. 67%, OR=3.13, P=0.03; 88% vs. 63%, OR=4.49, P=0.007, respectively). Literate patients had similar benefit at 12 months (OR=3.39 P=0.03), with improved virological outcomes associated with degree of literacy (P=0.003). A trend towards similar results was seen at 6 months for Koranically educated patients; however, this was no longer apparent at 12 months. No significant correlation was seen between socio-demographic characteristics and missed appointments.

Our study suggests that literacy, formal education and possibly Koranic education may impact favourably on adherence to ART.

Keywords:

• adherence
• HIV
• literacy
• education
• Koranic education

Acknowledgements

This work relies heavily on the current and former staff of the GUM clinic; in particular, those involved in pre-antiretroviral counselling (Ellen Manneh, Saydiba Tamba, Marie-Claire Mendy, Sheriff Kandeh and Sana Cham), doctors Ayesha Akinkugbe, Chris Akolo, Tahir Mohammed, Francis Oko and Toyin Togun, and Clayton Onyango for his unstinting efforts in the provision of viral loads. To them and to our patients we are deeply indebted.