Antiretroviral therapy initiation and adherence in rural South Africa: community health workers’ perspectives on barriers and facilitators

Loeliger, Kelsey; Niccolai, Linda M.; Mtungwa, Lillian N; Moll, Anthony; Shenoi, Sheela

doi:10.1080/09540121.2016.1164292

Cited by 46 publications

(58 citation statements)

References 47 publications

(78 reference statements)

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“…medical, and financial assistance) to informational and emotional support. 21,43 CHWs serve a key role in HIV-related care by providing a consistent source of home-based HIV/ART education, counseling, and support for patients and family members. By building relationships with patients over time, CHWs can effectively mitigate barriers to care such as stigma, denial, inadequate patient education, and poor social support.…”

Section: Discussionmentioning

confidence: 99%

“…Twenty-one CHWs with ‡2 years of experience working in Msinga were recruited by phone for participation in one of three focus groups. 21 To provide a sample with broad geographic representation of the Msinga neighborhoods, these participants were purposively selected from a list of all 51 CHWs working for the aforementioned local NGO's homebased care branch. 21 Since it was founded in 1999, this NGO has been employing CHWs for community outreach, with a particular focus on HIV/AIDS.…”

Section: Participant Recruitment and Informed Consentmentioning

confidence: 99%

“…17 Barriers to linkage to and retention in HIV care include denial, stigma, insufficient patient education, poor social support, socioeconomic limitations including transportation issues, fear of long-term therapy and its side effects, and lack of efficiency and accessibility within the healthcare system. 7,8,[10][11][12]14,[18][19][20][21][22] However, research on strategies to improve linkage to and retention in ART in sub-Saharan Africa remains limited. 23 In the setting of an already overburdened and rapidly expanding healthcare system, one component of the aforementioned scale-up has been the increasing use of community health workers (CHWs).…”

Section: Introductionmentioning

confidence: 99%

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“I Have to Push Him with a Wheelbarrow to the Clinic”: Community Health Workers' Roles, Needs, and Strategies to Improve HIV Care in Rural South Africa

Loeliger

Niccolai

Mtungwa

et al. 2016

AIDS Patient Care and STDs

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With a 19.2% HIV prevalence, South Africa has the largest HIV/AIDS epidemic worldwide. Despite a recent scale-up of public sector HIV resources, including community-based programs to expand HIV care, suboptimal rates of antiretroviral therapy (ART) initiation and adherence persist. As community stakeholders with basic healthcare training, community health workers (CHWs) are uniquely positioned to provide healthcare and insight into potential strategies to improve HIV treatment outcomes. The study goal was to qualitatively explore the self-perceived role of the CHW, unmet CHW needs, and strategies to improve HIV care in rural KwaZulu-Natal, South Africa. Focus groups were conducted in May-August 2014, with 21 CHWs working in Msinga subdistrict. Interviews were audio-recorded, transcribed, and translated from Zulu into English. A hybrid deductive and inductive analytical method borrowed from grounded theory was applied to identify emergent themes. CHWs felt they substantially contributed to HIV care provision but were inadequately supported by the healthcare system. CHWs' recommendations included: (1) sufficiently equipping CHWs to provide education, counseling, social support, routine antiretroviral medication, and basic emergency care, (2) modifying clinical practice to provide less stigmatizing, more patient-centered care, (3) collaborating with traditional healers and church leaders to reduce competition with ART and provide more holistic care, and (4) offsetting socioeconomic barriers to HIV care. In conclusion, CHWs can serve as resources when designing and implementing interventions to improve HIV care. As HIV/AIDS policy and practice evolves in South Africa, it will be important to recognize and formally expand CHWs' roles supporting the healthcare system.

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Section: Discussionmentioning

confidence: 99%

Section: Participant Recruitment and Informed Consentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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“I Have to Push Him with a Wheelbarrow to the Clinic”: Community Health Workers' Roles, Needs, and Strategies to Improve HIV Care in Rural South Africa

Loeliger

Niccolai

Mtungwa

et al. 2016

AIDS Patient Care and STDs

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“…Furthermore, numerous studies have examined the implications of traditional medicines and practices related to HIV treatment and management [28–31]. The traditional healing system has been claimed to be illogical, lacking in both scientific validity and suitable policies for its products and practices [32,33].…”

Section: Introductionmentioning

confidence: 99%

Traditional health practitioners’ management of HIV/AIDS in rural South Africa in the era of widespread antiretroviral therapy

Zuma

Wight

Rochat

et al. 2017

Global Health Action

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Background: Traditional health practitioners (THPs) have been identified as a key local resource in the fight against human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) in South Africa. However, their approaches to the treatment of people living with HIV (PLHIV) have been met with scepticism by some biomedical practitioners amid increasing access to antiretroviral therapy (ART). Objective: In light of this ambivalence, this study aims to document and identify treatment approaches of THPs to the management of illness among PLHIV in the current era of widespread access to ART. Methods: The study was conducted as part of a larger trial of Treatment as Prevention (TasP) in rural northern Kwa-Zulu Natal, intended to treat PLHIV regardless of CD4 count. Nine THPs were enrolled using purposive and snowballing techniques. Repeat group discussions, triangulated with community walks and photovoice techniques, were conducted. A thematic analysis approach was used to analyse the data. Results: Eight of the nine THPs had received training in biomedical aspects of HIV. THPs showed a multilayered decision-making process in managing illness among PLHIV, influenced by the attributes and choices of the THPs. THPs assessed and managed illness among PLHIV based on THP training in HIV/AIDS, THP type, as well as knowledge and experience in the traditional healing practice. Management of illness depended on the patients’ report of their HIV status or willingness to test for HIV. Conclusions: THPs’ approaches to illness in PLHIV appear to be shifting in light of increasing exposure to HIV/AIDS-related information. Importantly, disclosure of HIV status plays a major role in THPs’ management of illness among PLHIV, as well as linkage to HIV testing and care for their patients. Therefore, THPs can potentially enhance the success of ART for PLHIV when HIV status is known.

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“…In a study in Northern Namibian, 11% of respondents reported taking other traditional treatments together with ART [9]. It is noteworthy that a South African study reports that there is often tension between ARV treatment and alternative therapies [23]. Such beliefs present healthcare workers with a challenge to promote and foster adherence to ART among patients.…”

Section: Cultural and Religious Beliefs Related Factorsmentioning

confidence: 99%

Factors Associated with Non-Adherence to Antiretroviral Treatment in Adults at Keetmanshoop District State Hospital in Namibia

Dolamo¹

2017

ACRS

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BackgroundNamibia's Anti-Retroviral Therapy (ART) roll out has been very successful, achieving more than 84% coverage against a national target of 90% [1]. However, despite the successful role out of ART in Namibia, patients often fail to meet the level of adherence required for successful ART. The challenge of non-adherence to ART treatment has also been noted at the study site. In a study done in Nigeria, outcomes of non-adherence to ARV medication included viral resistance, treatment failure, toxicities and waste of financial resources [2]. Results from a study conducted in Botswana concluded that there is a strong correlation between adherence and clinical outcomes [3]. Given the large number of patients whose HIV infection will progress to AIDS if adherence is suboptimal, research is urgently needed to determine factors influencing adherence so that the most effective interventions to ensure adherence in African cohorts can be employed [4]. In a study in Ethiopia, 26.5% of the respondents had sub optimal adherence [5]. Locally, a recent study from Northern Namibia reported that 22% of respondents were non-adherent measured by pill count assessment. Henceforth this study envisaged to identify factors associated with non-adherence to ARV treatment in adult patients at Keetmanshoop hospital in Namibia.Focusing on the study site, in January 2015, the Keetmanshoop Hospital had 1289 adults receiving ART. On average, the clinic serves about 250 to 400 patients in a month. In the period October to December 2014 a total of 933 patients received follow-up care at the study site. Of these patients 53% (n=530) achieved required adherence scores of more than or equal to 95% while approximately 47% (n=403) achieved less than the required 95%. The suboptimal adherence rate in 47% of the patients 36.7% found in January 2015 at the Keetmanshoop Hospital was significantly higher than that reported in the Northern parts of the country. The Health Belief Model (HBM) was the theory of choice in this study due to its applicability to patient adherence and preventative health practices. The HBM has four major components [6,7]. HSOA Journal of AIDS Clinical Research and STDs Research ArticleAbstract Aim: To identify the factors associated with non-adherence to Antiretroviral Treatment (ART) amongst adult patients at a hospital in Namibia.Methods: Quantitative and qualitative approaches were employed, study sample of 112 adults aged 21 years and older at Keetmanshoop District State Hospital participated. Adherence to ART was assessed using the pill count and self-report methods. A questionnaire with a Cronbach value of 0.8 was used. Census and multi-stage sampling was applied. Data was collected from August to September 2016 through structured interviews and patients records review. Correlation of variables was done to remove multicollinearity. Stata version 12 was used for logistic regression to do univariate and multivariate analysis to determine factors associated with missing five or more doses. Results:In the univariate analy...

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Antiretroviral therapy initiation and adherence in rural South Africa: community health workers’ perspectives on barriers and facilitators

Cited by 46 publications

References 47 publications

“I Have to Push Him with a Wheelbarrow to the Clinic”: Community Health Workers' Roles, Needs, and Strategies to Improve HIV Care in Rural South Africa

“I Have to Push Him with a Wheelbarrow to the Clinic”: Community Health Workers' Roles, Needs, and Strategies to Improve HIV Care in Rural South Africa

Traditional health practitioners’ management of HIV/AIDS in rural South Africa in the era of widespread antiretroviral therapy

Factors Associated with Non-Adherence to Antiretroviral Treatment in Adults at Keetmanshoop District State Hospital in Namibia

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