Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa

Abstract

BackgroundSuccessful antiretroviral treatment is dependent on sustaining high rates of adherence. In the southern African context, only a handful of studies (both quantitative and qualitative) have looked at the determinants including a health behaviour theory of adherence to antiretroviral therapy. The aim of this study is to assess factors including the information, motivation and behavioural skills model (IMB) contributing to antiretroviral (ARV) adherence six months after commencing ARVs at three public hospitals in KwaZulu-Natal, South Africa.MethodsUsing systematic sampling, 735 HIV-positive patients were selected prior to commencing on ART from outpatient departments from three hospitals and followed-up at six months and interviewed with a questionnaire.ResultsA good proportion of patients were found to be adherent using both adherence instruments (visual analog scale = VAS 82.9%; Adult AIDS Clinical Trials Group = AATCG 70.8%). After adjusting for significant socio-economic variables, both the VAS and the dose, schedule and food adherence indicator found levels of adherence amongst urban residents to be almost 3 times greater than that of rural residents. After adjusting for health-related variables, for both indicators better adherence was associated with low depression and poorer adherence was associated with poor environmental factors. Adjusted odds ratios for adherence when taking into account different behavioural variables were for both adherence indicators, discrimination experiences were associated with lower adherence, and higher scores in adherence information and behavioural skills were associated with higher adherence. For the VAS adherence indicator, higher social support scores were associated with higher adherence. For the dose, schedule and food adherence indicator, using herbal medicines for HIV was associated with lower adherence.ConclusionFor the patients in this study, particularly those not living in urban areas, additional support may be needed to ensure patients are able to attend appointments or obtain their medications more easily. Adherence information and behavioural skills as part of the IMB model should be strengthened to improve adherence. Further psychological support is also required and patients' perceived need for ARTs should be routinely assessed.

The association between depression and adherence to antiretroviral therapy in HIV-positive patients, KwaZulu-Natal, South Africa

“…These adherence rates are similar to those of a study in KwaZulu-Natal using different measuring instruments. 16 Unemployment has been linked to poor adherence to ART in this study and in another South African setting. 32 These findings are not surprising as lack of finances is an enormous barrier to adherence in the African context.…”

“…Research conducted in KwaZulu-Natal among PLHIV attending three public hospitals showed that depression significantly increased the risk of non-adherence. 16 However, there is a lack of clinic-based data for South Africa despite the fact that the majority of people in this country access ART through clinic-based rather than hospital-based ART programmes.…”

“…These include a low CD4 count at the onset of ART, a relatively poor understanding of the disease and a lack of social support. 16 In addition, travelling costs, denial, waiting times at clinics, side effects of ART, use of traditional medicine, abuse of alcohol and being away from home have been identified as reasons for non-adherence in South Africa. 17 Globally, psychiatrists advocate increased integration of mental health services into HIV/AIDS care.…”

La mala calidad de sueño se asocia a una menor adherencia al tratamiento antirretroviral de gran actividad en pacientes peruanos con infección por VIH/SIDA

“…El nivel de adherencia adecuada encontrado en nuestro estudio es bajo (27%) y se encuentra en niveles inferiores a lo reportado por tres estudios desarrollados en Sudáfrica: 54,5%, 49,2% y 43,2% 56,57,58 . Esto podría estar relacionado al instrumento utilizado (CEAT-VIH).…”

Variables Psicológicas y Adhesión en Personas con VIH: Evaluación en función del Tiempo de Infección

“…Diversos estudios han mostrado la asociación entre el tiempo de infección (tiempo transcurrido desde el diagnós-tico de seropositividad al VIH) tanto con comportamientos de adhesión al tratamiento antirretroviral (Peltzer, Friend-du Prezz, Ramlagan & Anderson, 2010;Waldrop-Valverde, Jones, Jayaweera, González, Romero & Ownby, 2009) como con diversas variables biológicas y psicológicas, dentro de las que destacan el estadio clínico de infección, el afrontamiento de eventos estresantes y la percepción de apoyo social, entre otras (Gellaitry, Cooper, Davis, Fisher, Leake & Horne, 2005;Godin, Côté, Naccache, Lambert & Trottier, 2005;Heckman, Sikkema, Hansen, Kochman, Heh & Neufeld, 2010).…”