Social and economic barriers to adherence among patients at Livingstone General Hospital in Zambia.

Kaala Moomba,Brian Van Wyk

doi:10.4102/phcfm.v11i1.1740

Abstract

BackgroundZambia is one of the countries hardest hit by the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) pandemic with a national HIV prevalence estimated at 14% among those aged 15–49 years in 2012. Antiretroviral therapy (ART) has been available in public health facilities in Zambia since 2003. By early 2016, 65% of the 1.2 million Zambians living with HIV were accessing ART. While access to ART has improved the lives of people living with HIV globally, the lack of adherence to ART is a major challenge to treatment success globally.AimThis article reports on social and economic barriers to ART adherence among HIV patients being attended to at Livingstone General Hospital in Zambia.SettingLivingstone General Hospital is located in the Southern province of Zambia, and had over 7000 patients enrolled for HIV care of whom 3880 patients were on ART.MethodsAn explorative, qualitative study was conducted with 42 patients on ART where data were collected through six focus group discussions (3 male and 3 female groups) and seven in-depth interviews. Data were audio-recorded and transcribed verbatim and subjected to thematic content analysis.ResultsEconomic factors such as poverty and unemployment and the lack of food were reported as major barriers to adherence. Furthermore, social factors such as traditional medicine, religion, lack of family and partner support, and disclosure were also reported as critical barriers to adherence to ART.ConclusionInterventions to improve adherence among ART patients should aim to redress the socio-economic challenges at community and individual levels.

Highlights

Zambia has one of the largest human immunodeficiency virus (HIV) epidemics in sub-Saharan Africa, with a HIV prevalence of 14.3% in 2012 among the 15–49-year-old population.[1]
Of the estimated 36.9 million people living with HIV and/or acquired immune deficiency syndrome (AIDS) (PLWHA) globally by the end of 2014, Zambia accounted for approximately 1.2 million cases, with about 55 000 new infections among children and adults occurring in that same year.[2]
A review of the hospital data showed that there has been an increase in the number of patients that have been changed from the firstline regimen to the second-line therapy because of treatment failure, which is usually because of poor patient adherence to antiretroviral therapy (ART)

Summary

Introduction

Zambia has one of the largest human immunodeficiency virus (HIV) epidemics in sub-Saharan Africa, with a HIV prevalence of 14.3% in 2012 among the 15–49-year-old population.[1] Of the estimated 36.9 million people living with HIV and/or acquired immune deficiency syndrome (AIDS) (PLWHA) globally by the end of 2014, Zambia accounted for approximately 1.2 million cases, with about 55 000 new infections among children and adults occurring in that same year.[2] In 2002, the Zambian government made a commitment towards fighting the AIDS epidemic by adopting the National AIDS Strategic Framework, which provides an overall strategy for the planning, coordination and implementation of the multi-sectoral national response.[2] As of early 2016, over 70% of PLWHA eligible for antiretroviral therapy (ART) had been initiated on treatment in the country.[2]. While access to ART has improved the lives of people living with HIV globally, the lack of adherence to ART is a major challenge to treatment success globally

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