Barriers to ARV Adherence among HIV/AIDS Positive Persons taking Anti-Retroviral Therapy in Two Tanzanian Regions 8-12 Months after Program Initiation

Abstract

The purpose of this study was to measure adherence and to identify specific factors facilitating or constraining adherence to anti-retrovirals (ARVs) among HIV/AIDS patients. A cross sectional study on ARV adherence was conducted in two Tanzanian regions, Arusha and Dar es Salaam, in June and July 2005, involving 7 healthcare facilities in these regions. A multi-disciplinary team of researchers collected the data from two populations: the ARV users and the health care providers. The data was collected from the ARV users through exit interviews, semi structured interviews, adherence measures, focus group discussion and key informants interviews. From the health care staff, the tools used were semi structured interviews, observation of staff conducting consultations, and pharmacy stock check-ups. A total of 207 ARV users were studied, 26 observations were made, 28 health staff were interviewed, 8 focus group discussions and 10 key informant interviews were conducted, and 6 pharmacy stock checks were done in healthcare facilities. Results from the qualitative discussions, individual as well as institutional factors contributed to non-adherence. For many food, long waiting time, transportation, social supports, lack of education about anti-retroviral therapy (ART) or ARVs, lack or inadequate counseling, drug related side effects, and even knowledge about AIDS were barriers. Structural impediments such as stigma by untrained hospital care workers towards clients, over worked health care staff, and lack of space for confidential consultations, lack of availability of diagnostic and laboratory equipments were also sited as barriers. However, according to health staff, adherence was interpreted to mean using medicines as prescribed, at the right time and at the correct dosage, and attending the facilities as scheduled for follow-up checks. Many patients are appreciative of the government and of the health care workers involved in the programs. Yet, close attention and adequate supplies and resources to overcome the external barriers and attempts to try to mitigate the internal negative social determinants which prohibit adherence are needed. Unless due attention is paid to the critical issue of adherence, the emergence of drug-resistance will be accelerated and the expected early treatment achievements could be reversed.