Abstract
Patients' adherence to antiretroviral therapy (ART) is important for effective medical treatment of HIV/AIDS. We conducted a qualitative interview study in the Copperbelt Province of Zambia in 2006. The aim of the study was to explore patients' and health care professionals' perceived barriers and facilitators to patients' adherence to ART. Based on data from individual interviews and focus group interviews with a total of 60 patients and 12 health care professionals, we identified barriers and facilitators related to patients' beliefs and behaviours, the health service, and socio-economic and cultural factors. Among the barriers we identified were lack of communication and information about ART, inadequate time during consultations, lack of follow-up and counselling, forgetfulness, stigma, discrimination and disclosure of HIV status, lack of confidentiality in the treatment centres, and lack of nutritional support. Feeling better, prospects of living longer, family support, information about ART, support for income-generating activities, disclosure of HIV status, prayers and transport support were among the facilitators. Our study suggests that several issues need to be considered when providing ART. Further research is needed to study interactions between patients and their health care providers. Our findings can inform interventions to improve adherence to ART.
Highlights
Antiretroviral therapy (ART) has significantly improved the morbidity and mortality of individuals infected with HIV (Palella, Delaney, Moorman, Loveless, Fuhrer, Satten et al, 1998)
The findings from a recent systematic review indicated that adherence to ART among patients in sub-Saharan Africa compares favourably with adherence rates in North America: among the included African studies, 77% of the patients achieved adequate adherence, while the corresponding proportion from North-America was 55 % (17 573 patients) (Mills, Nachega, Buchan, Orbinski, Attaran, Singh et al, 2006)
Recruitment was done by health care professionals working in the clinics, who were asked to identify men and women aged between 20 and 49 years, who were HIV positive and used ART, and who were not too ill to participate in the study
Summary
Antiretroviral therapy (ART) has significantly improved the morbidity and mortality of individuals infected with HIV (Palella, Delaney, Moorman, Loveless, Fuhrer, Satten et al, 1998). Lack of adherence to highly active antiretroviral therapy (HAART) remains a key challenge to successful management of patients with HIV/AIDS. The findings from a recent systematic review indicated that adherence to ART among patients in sub-Saharan Africa compares favourably with adherence rates in North America: among the included African studies (totalling 12 116 patients), 77% of the patients achieved adequate adherence, while the corresponding proportion from North-America was 55 % (17 573 patients) (Mills, Nachega, Buchan, Orbinski, Attaran, Singh et al, 2006). The authors of the review stressed that ‘efforts to sustain adherence in Africa and elsewhere remain important goals to optimize outcomes for individuals and global HIV treatment.’
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