Barriers to adherence to antiretroviral treatment in a regional hospital in Vredenburg, Western Cape, South Africa

Azia, Ivo Nchendia; Mukumbang, Ferdinand C.; Wyk, Brian van

doi:10.4102/hivmed.v17i1.476

Cited by 8 publications

(6 citation statements)

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“…It is unclear whether hurried appointments were due to health provider attitudes, administrative burden or to high patient load. This supports qualitative data from the adult literature of the importance of the relationship and engagement with healthcare providers . Within Sub‐Saharan Africa, increasing use of community health workers and peer supporters within clinic settings (e.g.…”

Section: Discussionsupporting

confidence: 74%

STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa

et al. 2018

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IntroductionThere are two million HIV‐positive adolescents in southern Africa, and this group has low retention in care and high mortality. There is almost no evidence to identify which healthcare factors can improve adolescent self‐reported retention. This study examines factors associated with retention amongst antiretroviral therapy (ART)‐initiated adolescents in South Africa.MethodsWe collected clinical records and detailed standardized interviews (n = 1059) with all 10‐ to 19 year‐olds ever initiated on ART in all 53 government clinics of a health subdistrict, and community traced to include lost‐to‐follow‐up (90.1% of eligible adolescents interviewed). Associations between full self‐reported retention in care (no past‐year missed appointments and 85% past‐week adherence) and health service factors were tested simultaneously in sequential multivariate regression and marginal effects modelling, controlling for covariates of age, gender, urban/rural location, formal/informal housing, maternal and paternal orphanhood, vertical/horizontal HIV infection, overall health, length of time on ART and type of healthcare facility.ResultsAbout 56% of adolescents had self‐reported retention in care, validated against lower detectable viral load (AOR: 0.63, CI: 0.45 to 0.87, p = 0.005). Independent of covariates, five factors (STACK) were associated with improved retention: clinics Stocked with medication (OR: 3.0, CI: 1.6 to 5.5); staff with Time for adolescents (OR: 2.7, CI: 1.8 to 4.1); adolescents Accompanied to the clinic (OR: 2.3, CI: 1.5 to 3.6); enough Cash to get to clinic safely (OR: 1.4, CI: 1.1 to 1.9); and staff who are Kind (OR: 2.6, CI: 1.8 to 3.6). With none of these factors, 3.3% of adolescents reported retention. With all five factors, 69.5% reported retention.ConclusionsThis study identifies key intervention points for adolescent retention in HIV care. A basic package of clinic and community services has the potential to STACK the odds for health and survival for HIV‐positive adolescents.

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Section: Discussionsupporting

confidence: 74%

STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa

et al. 2018

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“…is might be due to long travel distance to health facility because large proportion of participants in the current study were from rural residence. Previous studies also showed that long travel distance and lack of money for traveling to health institution affect ART adherence and follow-up visit within the recommended time [17,18]. Besides, the median time to complete the enhanced adherence counseling session was greater than 24 weeks in men, which is very far away from the suggested time [3,10,12].…”

Section: Discussionmentioning

confidence: 99%

Viral Load Suppression after Enhanced Adherence Counseling and Its Predictors among High Viral Load HIV Seropositive People in North Wollo Zone Public Hospitals, Northeast Ethiopia, 2019: Retrospective Cohort Study

Diress

Dagne

Alemnew

et al. 2020

AIDS Research and Treatment

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Background. The World Health Organization currently encourages enhanced adherence counseling for human immunodeficiency virus (HIV) seropositive people with a high viral load count before a treatment switch to the second-line regimen, yet little is known about viral load suppression after the outcome of enhanced adherence counseling. Therefore, this study aimed to assess viral suppression after enhanced adherence counseling sessions and its predictors among high viral load HIV seropositive people. Methods. Institutional-based retrospective cohort study was conducted among 235 randomly selected HIV seropositive people who were on ART and had a high viral load (>1000 copies/ml) from June 2016 to January 2019. The proportion of viral load suppression after enhanced adherence counseling was determined. Time to completion of counseling sessions and time to second viral load tests were estimated by the Kaplan–Meier curve. Log binomial regression was used to identify predictors of viral re-suppression after enhanced adherence counseling sessions. Result. The overall viral load suppression after enhanced adherence counseling was 66.4% (60.0–72.4). The median time to start adherence counseling session after high viral load detected date was 8 weeks (IQR 4–8 weeks), and the median time to complete the counseling session was 13 weeks (IQR 8–25 weeks). The probability of viral load suppression was higher among females (ARR = 1.2, 95% CI: 1.02–1.19) and higher educational status (ARR = 1.7, 95% CI: 1.25–2.16). The probability of viral load suppression was lower among people who had 36–59 months duration on ART (ARR = 0.35, 95% CI: 0.130–0.9491) and people who had > 10,000 baseline viral load count (ARR = 0.44, 95% CI: 0.28–0.71). Conclusion. This study showed that viral suppression after enhanced adherence counseling was near to the WHO target (70%) but highlights gaps in time to enrolment into counseling session, timely completion of counseling session, and repeat viral load testing after completing the session.

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“…The complexities and interrelatedness of the factors influencing behaviour of PLHIV, including barriers and facilitators, can be found in multiple dimensions for linkage to ART [31], adherence to ART [32][33][34] and retention in care [35,36]. The dimensions within which barriers and facilitators are understood in this overview are based on the Kaufman and colleagues HIV Behaviour Change Model [23].…”

Section: Overview Designmentioning

confidence: 99%

“…Adherence to ART Fig. 1 Steps of the overview using mega-aggregation framework synthesis of qualitative systematic reviews refers to the extent to which a person who is HIV positive follows their prescribed regimen of care and takes their medication as they should [33,34]. Since the introduction of ART, there has been a decline in AIDSrelated deaths and life expectancy for those infected with HIV has increased [15].…”

Section: Types Of Reviewsmentioning

confidence: 99%

A mega-aggregation framework synthesis of the barriers and facilitators to linkage, adherence to ART and retention in care among people living with HIV

2021

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Background People living with human immunodeficiency virus (PLHIV) struggle with the challenges of living with a chronic disease and integrating antiretroviral treatment (ART) and care into their daily lives. The aims of this study were as follows: (1) to undertake the first mega-aggregation of qualitative evidence syntheses using the methods of framework synthesis and (2) make sense of existing qualitative evidence syntheses that explore the barriers and facilitators of adherence to antiretroviral treatment, linkage to care and retention in care for PLHIV to identify research gaps. Methods We conducted a comprehensive search and did all screening, data extraction and critical appraisal independently and in duplicate. We used the Kaufman HIV Behaviour Change model (Kaufman et al., 2014) as a framework to synthesise the findings using the mega-aggregative framework synthesis approach, which consists of 8 steps: (1) identify a clearly defined review question and objectives, (2) identify a theoretical framework or model, (3) decide on criteria for considering reviews for inclusion, (4) conduct searching and screening, (5) conduct quality appraisal of the included studies, (6) data extraction and categorisation, (7) present and synthesise the findings, and (8) transparent reporting. We evaluated systematic reviews up to July 2018 and assessed methodological quality, across reviews, using the Joanna Briggs Institute Critical Appraisal Checklist for Systematic Reviews. Results We included 33 systematic reviews from low, middle- and high-income countries, which reported on 1,111,964 PLHIV. The methodological quality of included reviews varied considerably. We identified 544 unique third-order concepts from the included systematic reviews, which were reclassified into 45 fourth-order themes within the individual, interpersonal, community, institutional and structural levels of the Kaufman HIV Behaviour Change model. We found that the main influencers of linkage, adherence and retention behaviours were psychosocial and personal characteristics—perceptions of ART, desires, fears, experiences of HIV and ART, coping strategies and mental health issues—interwoven with other factors on the interpersonal, community, institutional and structural level. Using this approach, we found interdependence between factors influencing ART linkage, retention and adherence and identified the need for qualitative evidence that explores, in greater depth, the complex relationships between structural factors and adherence, sociodemographic factors such as community violence and retention, and the experiences of growing up with HIV in low- and middle-income countries—specifically in children, youth, women and key populations. Conclusions This is the first mega-aggregation framework synthesis, or synthesis of qualitative evidence syntheses using the methods of framework synthesis at the overview level. We found the novel method to be a transparent and efficient method for assessing the quality and making sense of existing qualitative systematic reviews. Systematic review registration The protocol of this overview was registered on PROSPERO (CRD42017078155) on 17 December 2017.

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Barriers to adherence to antiretroviral treatment in a regional hospital in Vredenburg, Western Cape, South Africa

Cited by 8 publications

References 0 publications

STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa

STACKing the odds for adolescent survival: health service factors associated with full retention in care and adherence amongst adolescents living with HIV in South Africa

Viral Load Suppression after Enhanced Adherence Counseling and Its Predictors among High Viral Load HIV Seropositive People in North Wollo Zone Public Hospitals, Northeast Ethiopia, 2019: Retrospective Cohort Study

A mega-aggregation framework synthesis of the barriers and facilitators to linkage, adherence to ART and retention in care among people living with HIV

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