Exploring antiretroviral treatment adherence in an urban setting in South Africa

Abstract

Antiretroviral treatment requires high levels of adherence to be effective. This qualitative study explores the reasons for poor adherence among 22 purposively selected poor urban participants in South Africa. Over a 4-month period in 2009, we prospectively investigated experiences of HIV diagnosis and treatment, adherence, and withdrawal from treatment. Patients with no stable food sources faced significant barriers in adhering to treatment regimens and staying sufficiently healthy to search for, obtain or retain a job. The narratives also identify the influence on adherence of self-esteem and social support, vulnerability generated by ill health, gendered conflict, social inequities amplified by HIV, and exhaustion due to the social burden of the epidemic. Multi-dimensional, inter-sectoral programs that tackle the social determinants of health, such as food insecurity, poverty, gendered inequities, and treatment adherence are more likely to be successful, than single interventions to support adherence.

Determinants of Antiretroviral Therapy Adherence among Women in Southern Malawi: Healthcare Providers’ Perspectives

“…Cantrell and colleagues found in their pilot study of food supplementation to improve adherence to ART that food supplements were associated with better adherence of HIV patients in Zambia [33]. Some patients stop taking their medication because of lack of access to food and their perception of side effects associated with taking medication without food, which is supported by other studies [34–36]. …”

TB and HIV stigma compounded by threatened masculinity: implications for TB health-care seeking in Malawi

“…live without physical markers of illness'. 50 However, studies continue to describe PLHIV on treatment struggling with fears of death, rumours about the side effects of ART, and anxieties related to poverty and unemployment 51 and the threat of transmitting infection. 52 Although they cherish recovery and strive to shed the 'sick identity', PLHIV frequently encounter situations that remind them of their difference and exclude them from society.…”

Alcohol use, antiretroviral therapy adherence, and preferences regarding an alcohol-focused adherence intervention in patients with human immunodeficiency virus

“…The perceived importance of addressing food insecurity in an ART adherence-related intervention is not surprising, given that most of the participants were unemployed and about a third reported having missed ART doses due to a lack of food; and just under two thirds indicated a significant degree of food insecurity. Moreover, food insecurity has been cited as a notable barrier to ART adherence 60,77–79…”