Abstract
Multiple factors make adherence to antiretroviral therapy (ART) a complex process. This study aims to describe the barriers and facilitators to adherence for patients receiving first-line and second-line ART, identify different adherence strategies utilized and make recommendations for an improved adherence strategy. This mixed method parallel convergent study will be conducted in seven high volume public health facilities in Gauteng and one in Limpopo province in South Africa. The study consists of four phases; a retrospective secondary data analysis of a large cohort of patients on ART (using TIER.Net, an ART patient and data management system for recording and monitoring patients on ART and tuberculosis (TB)) from seven Johannesburg inner-city public health facilities (Gauteng province); a secondary data analysis of the Intensified Treatment Monitoring Accumulation (ITREMA) trial (a randomized control trial which ran from June 2015 to January 2019) conducted at the Ndlovu Medical Center (Limpopo province); in-depth interviews with people living with Human Immunodeficiency Virus (PLHIV) who are taking ART (in both urban and rural settings); and a systematic review of the impact of treatment adherence interventions for chronic conditions in sub-Saharan Africa. Data will be collected on demographics, socio-economic status, treatment support, retention in care status, disclosure, stigma, clinical markers (CD4 count and viral load (VL)), self-reported adherence information, intrapersonal, and interpersonal factors, community networks, and policy level factors. The systematic review will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting and Population, Interventions, Comparisons and Outcomes (PICO) criteria. Analyses will involve tests of association (Chi-square and t-test), thematic analysis (deductive and inductive approaches) and network meta-analysis. Using an integrated multilevel socio-ecological framework this study will describe the factors associated with adherence for PLHIV who are taking first-line or second-line ART. Implementing evidence-based adherence approaches, when taken up, will improve patient's overall health outcomes. Our study results will provide guidance regarding context-specific intervention strategies to improve ART adherence.
Highlights
Inconsistent adherence to treatment is a contributing factor to poor health outcomes of people affected by numerous health conditions, including HIV, tuberculosis, diabetes mellitus (DM) and hypertension [1,2,3]
World Health Organization (WHO) recommends the use of the HIV drug dolutegravir (DTG) as the preferred first-line and second-line antiretroviral therapy (ART) treatment regimens for all populations due to its formidable resistance barrier and improved tolerability [10,11,12]
The overarching aim of this study is to contribute to knowledge that can provide guidance regarding the barriers and facilitators to adherence for first-line and second-line ART patients and different adherence strategies utilized
Summary
Inconsistent adherence to treatment is a contributing factor to poor health outcomes of people affected by numerous health conditions, including HIV, tuberculosis, diabetes mellitus (DM) and hypertension [1,2,3]. Our study will adapt the socio-ecological conceptual framework to investigate multilevel and interactive factors such as individual/intrapersonal, interpersonal, community, and health policy level factors that affect adherence to ART (Fig 1) It will explore the different aspects of these factors that act either as barriers or facilitators of adherence to ART. 2. What are the intra-and inter-personal factors (demographic, socio-economic characteristics), social and community level factors (poverty, social norms, HIV related stigma, culture), structural factors (health systems, support services) and clinical indicators associated with self reported adherence, pill count and virological failure to first-line and second-line ART in rural communities? What treatment adherence strategies and interventions have been implemented and evaluated in sub-Saharan Africa for HIV, hypertension, and DM? Hypothesis: There are no differences in the effectiveness of adherence interventions implemented in sub-Saharan Africa for HIV, hypertension, and DM
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