Personal barriers to antiretroviral therapy adherence: Case studies from a rural Uganda prospective clinical cohort

J Seeley,Bn Mayanja,R Lubega,P Kaleebu,B Masiira,E Kabunga

doi:10.4314/ahs.v13i2.16

Abstract

Although good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes, some patients may have specific personal barriers to ART adherence. To study specific personal barriers to ART adherence. Quantitative data on patients' health status, ART adherence, CD4 cell counts and viral loads were collected, and qualitative data on life experiences of five patients with poor ART outcomes and adherence were also collected. Out of 35 patients with poor immunological and virological ART outcomes, 17 (49%) also had poor ART adherence. Patient 1 had no living child and did not disclose her HIV serostatus to her spouse because she wanted to have a child. Patient 2 was an orphan with neither social nor family support. Patient 3 stopped ART when she conceived, returned to the study clinic when pregnant again and was sickly. She was switched to second-line ART with satisfactory outcomes. Patient 4, a 14 year old orphan had missed ART for 2 months when his treatment supporter was away. Patient 5 aged 66 years stopped ART which he blamed for his erectile dysfunction. ART adherence counselling should target specific personal barriers to ART adherence like: lack of family support, health and sexual life concerns, desire to have children and family instability.

Highlights

Since the universal rollout of antiretroviral therapy (ART), the natural history of HIV infection has changed from a fatal disease to a chronic manageable condition[1]
By the end of 2010, out of an estimated 10.4 million people who were eligible for ART in sub-Saharan Africa, 5.064 million (49%) were receiving it
To achieve successful treatment outcomes, good ART adherence is vital some individuals may not achieve good adherence to ART leading to poor viral suppression[10,11]

Summary

Introduction

Since the universal rollout of antiretroviral therapy (ART), the natural history of HIV infection has changed from a fatal disease to a chronic manageable condition[1]. By the end of 2010, out of an estimated 10.4 million people who were eligible for ART in sub-Saharan Africa, 5.064 million (49%) were receiving it. To achieve successful treatment outcomes, good ART adherence is vital some individuals may not achieve good adherence to ART leading to poor viral suppression[10,11]. Good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes, some patients may have specific personal barriers to ART adherence. Patient 3 stopped ART when she conceived, returned to the study clinic when pregnant again and was sickly She was switched to second-line ART with satisfactory outcomes. Conclusions: ART adherence counselling should target specific personal barriers to ART adherence like: lack of family support, health and sexual life concerns, desire to have children and family instability.

Objectives

Methods

Results

Conclusion