Post-ART Symptoms Were Not the Problem: A Qualitative Study on Adherence to ART in HIV-Infected Patients in a Mozambican Rural Hospital

Abstract

ObjectiveThe objective of this qualitative study was to explore how clinical symptoms may affect adherence to antiretroviral therapy (ART) in HIV patients, and to explore factors, perceptions and attitudes related to adherence to therapy.DesignA qualitative study was carried out in the context of the prospective cohort study “Evaluation of Immune Reconstitution Following Initiation of Highly Active Antiretroviral Treatment in Manhiça, Mozambique”. In-depth Interviews were conducted twice in a sub-sample of the study cohort (51 participants), at six-month intervals.ResultsMost participants (73%) knew that AIDS is a chronic disease and that ART does not cure it. Nine participants (18%) were non-adherent at some point and two (4%) abandoned ART. All participants but five reported having symptoms after starting ART, mainly attributed to pills needing time to act and body’s reaction to the treatment. In spite of the perceived severity of the symptoms, only two people reported they discontinued the treatment due to symptoms. Almost all participants reported feeling comfortable with the HIV clinic organization and procedures, but afraid of staff being hostile if they did not follow the rules or if the health worker visited their home. Family was one of the most important source of support according participants. Almost all participants with children said that a decisive factor to follow the treatment was the desire to be able to look after them.ConclusionsExperiencing symptoms after starting treatment was not a barrier to adherence to ART. Factors related to adherence included control measures set up by the health facility (exhaustive follow up, support, information) and family and community support. Indirect ART-related expenses did jeopardise adherence.

Factors affecting adherence to antiretroviral therapy among pregnant women in the Eastern Cape, South Africa

“…Participants’ narratives show that side effects are the most reported reason for non-adherence. This finding is consistent with previous studies [ 39 – 41 ]; however, a study shows that experiencing symptoms after starting treatment was not a barrier to adherence to ART [ 42 ]. The commonly reported side effect of ARV in this study was vomiting.…”

Tipping the balance towards long-term retention in the HIV care cascade: A mixed methods study in southern Mozambique

“…In our study, one of the important patient-reported cross-cutting issues that emerged through all steps of the cascade was the relationship between the health system and the patient, which had a bivalent and cumulative effect along the continuum. On one hand, responses from PLWHIV from our study reflected a strong authoritarian and vertical relationship where the health system was in the position of power and the patient occupied the lowest level and complied with the norms and laws [46] of the hospital. Indeed, studies conducted in Uganda and Sudan shown that less half of the patients and health providers are aware of the existence of national Charter of patients’ rights, increasing client vulnerability [47,48].…”

HIV infection in Eastern and Southern Africa: Highest burden, largest challenges, greatest potential

“…Retention in care is improved by feeling better after ART initiation, confidence in the health system and support from family and providers. 27 Communication about continuing treatment despite feeling better also helps. 24 Barriers to retention include provider authoritarianism, which limits patient autonomy and engagement in their healthcare, and the adverse effects of ART.…”

“… 24 Barriers to retention include provider authoritarianism, which limits patient autonomy and engagement in their healthcare, and the adverse effects of ART. 27 Men across the region are a hard-to-reach group; they test less, and more abandon ART after initiation. 22 There are additional complexities related to paediatric care, such as the health literacy of parents and their confidence in managing HIV.…”