"That is why I stopped the ART": patients' & providers' perspectives on barriers to and enablers of HIV treatment adherence in a South African workplace programme

Mison Dahab, Salome Charalambous, Robin Hamilton, Katherine Fielding, Karina Kielmann, Gavin J Churchyard, Alison D Grant, Mison Dahab, Salome Charalambous, Robin Hamilton, Katherine Fielding, Karina Kielmann, Gavin J Churchyard, Alison D Grant

Abstract

Background: As ART programmes in African settings expand beyond the pilot stages, adherence to treatment may become an increasing challenge. This qualitative study examines potential barriers to, and facilitators of, adherence to ART in a workplace programme in South Africa.

Methods: We conducted key informant interviews with 12 participants: six ART patients, five health service providers (HSPs) and one human resources manager.

Results: The main reported barriers were denial of existence of HIV or of one's own positive status, use of traditional medicines, speaking a different language from the HSP, alcohol use, being away from home, perceived severity of side-effects, feeling better on treatment and long waiting times at the clinic. The key facilitators were social support, belief in the value of treatment, belief in the importance of one's own life to the survival of one's family, and the ability to fit ART into daily life schedules.

Conclusion: Given the reported uncertainty about the existence of HIV disease and the use of traditional medicines while on ART, despite a programme emphasising ART counselling, there is a need to find effective ways to support adherence to ART even if the individual does not accept biomedical concepts of HIV disease or decides to use traditional medicines. Additionally, providers should identify ways to minimize barriers in communication with patients with whom they have no common language. Finally, dissatisfaction with clinical services, due to long waiting times, should be addressed.

References

    1. World Health Organization. UNAIDS. UNICEF . Towards universal access. Scaling up priority HIV/AIDS interventions in the health sector Progress Report. WHO; 2007.
    1. Palella FJ, Palella FJ Jr. Delaney KM. Moorman AC. Loveless MO. Fuhrer J. Satten GA. Aschman DJ. SD H. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. New England Journal of Medicine. 1998;338:853–860. doi: 10.1056/NEJM199803263381301.
    1. Mocroft A, Ledergerber B, Katlama C, Kirk O, Reiss P, d'Arminio MA, Knysz B, Dietrich M, Phillips AN, Lundgren JD. Decline in the AIDS and death rates in the EuroSIDA study: an observational study. . Lancet. 2004;362:22–29. doi: 10.1016/S0140-6736(03)13802-0.
    1. Bangsberg DR. Less than 95% adherence to nonnucleoside reverse-transcriptase inhibitor therapy can lead to viral suppression. Clinical Infectious Diseases. 2006;43:939–941. doi: 10.1086/507526.
    1. Nachega JB, Hislop M, Dowdy DW, Chaisson RE, Regensberg L, Maartens G. Adherence to nonnucleoside reverse transcriptase inhibitor-based HIV therapy and virologic outcomes. Annals of Internal Medicine. 2007;146:564–573.
    1. Bangsberg DR, Acosta EP, Gupta R, Guzman D, Riley ED, Harrigan PR, Parkin N, Deeks SG. Adherence-resistance relationships for protease and non-nucleoside reverse transcriptase inhibitors explained by virological fitness. AIDS. 2006;20:223–231. doi: 10.1097/01.aids.0000199825.34241.49.
    1. Mills EJ, Nachega JB, Buchan I, Orbinski J, Attaran A, Singh S, Rachlis B, Wu P, Cooper C, Thabane L, Wilson K, Guyatt G, Bangsberg DR. Adherence to Antiretroviral Therapy in Sub-Saharan Africa and North America. A Meta-Analysis. JAMA. 2006;296:679–690. doi: 10.1001/jama.296.6.679.
    1. Montessori V, Wood E, Beer SL. Virologic success rates drop off sharply with decreasing levels of adherence to antiretroviral therapy. Durban, South Africa; 2000.
    1. Palepu A, Yip B, Miller C, Strathdee SA, O'Shaughnessy MV, Montaner JS. Factors associated with the response to antiretroviral therapy among HIV-infected patients with and without a history of injection drug use. AIDS. 2001;15:423–424. doi: 10.1097/00002030-200102160-00021.
    1. Gifford A, Bormann J, Shively M, Wright B, Richman D, Bozzette S. Predictors of self-reported adherence and plasma HIV concentrations in patients on multidrug antiretroviral regimens. Journal of Acquired Immune Deficiency Syndrome. 2000;23:386–395.
    1. Haubrich RH, Little SJ, Currier JS, Forthal D, Cemper C, Beall G, Johnson D, Dube M, Hwang J, McCutchan A. The value of patient-reported adherence to antiretroviral therapy in predicting virologic and im- munologic response. AIDS. 1999;13:1099–1107. doi: 10.1097/00002030-199906180-00014.
    1. Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, Wu P, Wilson K, Buchan I, Gill CJ, Cooper C. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLOS Medicine. 2006;3:e438. doi: 10.1371/journal.pmed.0030438.
    1. Weiser S, Wolfe W, Bangsberg D, Thior I, Gilbert P, Makhema J, Kebaabetswe P, Dickenson D, Mompati K, Essex M, Marlink R. Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. Journal of Acquired Immune Deficiency Sydrom. 2003;34:281–288. doi: 10.1097/00126334-200311010-00004.
    1. Laniece I, Ciss M, Desclaux A, Diop K, Mbodj F, Ndiaye B, Sylla O, Delaporte E, Ndoye I. Adherence to HAART and its principal determinants in a cohort of Senegalese adults. AIDS. 2003;17 Suppl 3:S103–8.
    1. Byakika-Tusiime J, Oyugi JH, Tumwikirize WA, Katabira ET, Mugyenyi PN, Bangsberg D. Adherence to HIV antiretroviral therapy in HIV+ Ugandan patients purchasing therapy. International Journal of STD & AIDS. 2005;16:38–41. doi: 10.1258/0956462052932548.
    1. Molassiotis A, Nahas-Lopez V, Chung WYR, Lam SWC, Li CKP, Lau TFJ. Factors associated with adherence to antiretroviral medication in HIV infected patients. International Journal of STD & AIDS. 2002;13:301–310. doi: 10.1258/0956462021925117.
    1. Pinheiro CA, de-Carvalho-Leite JC, Drachler ML, Silveira VL. Factors associated with adherence to antiretroviral therapy in HIV/AIDS patients: a cross-sectional study in Southern Brazil. Braz J Med Biol Res. 2002;35:1173–1181. doi: 10.1590/S0100-879X2002001000010.
    1. Carvalho CV, Duarte DB, Merchan-Hamann E, Bicudo E, Laguardia J. Predictors of compliance with highly active antiretroviral therapy in Brasilia, Distrito Federal, Brazil, 1999-2000. Cad Saude Publica. 2003;19:593–604.
    1. Monreal MT, da Cunha RV, Trinca LA. Compliance to antiretroviral medication as reported by AIDS patients assisted at the University Hospital of the Federal University of Mato Grosso do Sul. Brazilian Journal of Infectious Disease. 2002;6:8–14.
    1. Nachega J, Stein DM, Lehman DA, Hlatshwayo D, Mothopeng R, Chaisson RE, Karstaedt AS. Adherence to Antiretroviral Therapy in HIV-Infected Adults in Soweto, South Africa. AIDS Research and Human Retroviruses. 2004;20:1053–1056. doi: 10.1089/aid.2004.20.1053.
    1. Nemes MI, de Carvalho CV, Souza MF. Antiretroviral therapy adherence in Brazil. AIDS. 2004;Supp 13 :S15–20. doi: 10.1097/00002030-200406003-00004.
    1. Green J, Thorogood N. Qualitative Methods for Health Research. 1. London , Sage publications; 2004. p. 262.
    1. Babb DA, Pemba L, Seatlanyane P, Charalambous S, Churchyard GJ, Grant AD. Use of traditional medicine by HIV-infected individuals in South Africa in the era of antiretroviral therapy. Psychology, Health & Medicine. 2007;12:314–320. doi: 10.1080/13548500600621511.
    1. Dahab M, Hamilton R, Charalambous S, Dube N, Tsimele J, Govender N, Puso T, Dwadwa T, Kielmann K, Fielding K, Churchyard G, Grant A. A quantitative study of barriers & facilitators to adherence in an antiretroviral therapy programme in South Africa : Toronto, Canada. 2006.
    1. Reynolds NR. Adherence to antiretroviral therapies: state of the science. Current HIV Research. 2004;2:207–214. doi: 10.2174/1570162043351309.
    1. Stone VE. Strategies for optimizing adherence to highly active antiretroviral therapy: lessons from research and clinical practice. Clinical Infectious Diseases. 2001;33:865–872. doi: 10.1086/322698.
    1. Ickovics JR, Meisler AW. Adherence in AIDS clinical trials: A framework for clinical research adn clinical care. Clinical Epidemiology. 1997;50:385–391. doi: 10.1016/S0895-4356(97)00041-3.
    1. Orrell C, Bangsberg D, Badri M, Wood R. Adherence is not a barrier to successful antiretroviral therapy in South Africa. AIDS. 2003;17:1369–1375. doi: 10.1097/00002030-200306130-00011.

Source: PubMed

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