Personal Factors Influencing Patients' Adherence to ART in Addis Ababa, Ethiopia

Negash, Tefera G; Ehlers, V.J.

doi:10.1016/j.jana.2012.11.004

Cited by 32 publications

(30 citation statements)

References 7 publications

(9 reference statements)

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“…Stigmatization and discrimination are complex socio-cultural phenomena that arise from the perception that a person with HIV/AIDS has unwanted qualities, thus reducing him in the eye of society [31]. Perceived stigma (felt stigma) and discrimination and lack of privacy to take and collect medication hindered adherence to ART in this study; these factors were also identified in other sub-Saharan and Far-East Asian studies [19], [32], [33], [34], [35], [36]. As reported by other authors [26], patients in this study had concerns about being stigmatized and losing their jobs if their HIV status was discovered when they took pills in front of work colleagues or asked permission from their employers to collect medications at appointment dates.…”

Section: Discussionmentioning

confidence: 57%

Barriers and Facilitators of Adherence to Antiretroviral Drug Therapy and Retention in Care among Adult HIV-Positive Patients: A Qualitative Study from Ethiopia

et al. 2014

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BackgroundAntiretroviral therapy (ART) has been life saving for hundreds of thousands of Ethiopians. With increased availability of ART in recent years, achievement of optimal adherence and patient retention are becoming the greatest challenges in the management of HIV/AIDS in Ethiopia. However, few studies have explored factors influencing medication adherence to ART and retention in follow-up care among adult Ethiopian HIV-positive patients, especially in the Amhara region of the country, where almost one-third of the country’s ART is prescribed. The aim of this qualitative study was to collect such data from patients and healthcare providers in the Amhara region of Ethiopia.MethodsSemi-structured interviews were conducted with 24 patients, of whom 11 had been lost to follow-up and were non-persistent with ART. In addition, focus group discussions were performed with 15 ART nurses and 19 case managers. All interviews and focus groups were audio-recorded, transcribed, and coded for themes and patterns in Amharic using a grounded theory approach. The emergent concepts and categories were translated into English.ResultsEconomic constraints, perceived stigma and discrimination, fasting, holy water, medication side effects, and dissatisfaction with healthcare services were major reasons for patients being non-adherent and lost to follow-up. Disclosure of HIV status, social support, use of reminder aids, responsibility for raising children, improved health on ART, and receiving education and counseling emerged as facilitators of adherence to ART.ConclusionsImproving adherence and retention requires integration of enhanced treatment access with improved job and food security. Healthcare providers need to be supported to better equip patients to cope with the issues associated with ART. Development of social policies and cooperation between various agencies are required to facilitate optimal adherence to ART, patient retention, and improved patient outcomes.

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Section: Discussionmentioning

confidence: 57%

Barriers and Facilitators of Adherence to Antiretroviral Drug Therapy and Retention in Care among Adult HIV-Positive Patients: A Qualitative Study from Ethiopia

et al. 2014

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“…In one investigation, Omosanya et al [68] reported a significant association between stigma and adherence difficulties in multivariate analyses, after controlling for demographics and medication usage duration. Two other investigations found univariate associations between stigma and adherence, but did not conduct multivariate analyses [69,70]. In contrast, Carlucci et al [71] did not find a significant univariate association between stigma and adherence.…”

Section: Studies Where Stigma Measure Was Unclearmentioning

confidence: 94%

The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature

2015

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This paper provides a review of the quantitative literature on HIV-related stigma and medication adherence, including: (1) synthesis of the empirical evidence linking stigma to adherence, (2) examination of proposed causal mechanisms of the stigma and adherence relationship, and (3) methodological critique and guidance for future research. We reviewed 38 studies reporting either cross-sectional or prospective analyses of the association of HIV-related stigma to medication adherence since the introduction of antiretroviral therapies (ART). Although there is substantial empirical evidence linking stigma to adherence difficulties, few studies provided data on psychosocial mechanisms that may account for this relationship. Proposed mechanisms include: (a) enhanced vulnerability to mental health difficulties, (b) reduction in self-efficacy, and (c) concerns about inadvertent disclosure of HIV status. Future research should strive to assess the multiple domains of stigma, use standardized measures of adherence, and include prospective analyses to test mediating variables.

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“…Poor understanding of HIV and effects of ART has been associated with a higher likelihood of non-adherence [1] and dropping out of care both in high-income settings [2–4] and in sub-Saharan Africa [5–8], although some studies report weak or no associations [9–11]. Traditional medicine use, a factor often closely linked to an individual’s belief system, has also emerged as a barrier to ART in the region [12–15].…”

Section: Introductionmentioning

confidence: 99%

HIV Care and Treatment Beliefs among Patients Initiating Antiretroviral Treatment (ART) in Oromia, Ethiopia

et al. 2015

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To better understand patient beliefs, which may influence adherence to HIV care and treatment, we examined three dimensions of beliefs among Ethiopian adults (n = 1177) initiating antiretroviral therapy (ART). Beliefs about benefits of ART/HIV clinical care were largely accurate, but few patients believed in the ability of ART to prevent sexual transmission and many thought Holy Water could cure HIV. Factors associated with lower odds of accurate beliefs included advanced HIV, lack of formal education, and Muslim religion (benefits of ART/clinical care); secondary or university education and more clinic visits (ART to prevent sexual transmission); and pregnancy and Orthodox Christian religion (Holy Water). Assessment of patient beliefs may help providers identify areas needing reinforcement. In this setting, counselors also need to stress the benefits of ART as prevention and that Holy Water should not be used to the exclusion of HIV care and ART.

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Personal Factors Influencing Patients' Adherence to ART in Addis Ababa, Ethiopia

Cited by 32 publications

References 7 publications

Barriers and Facilitators of Adherence to Antiretroviral Drug Therapy and Retention in Care among Adult HIV-Positive Patients: A Qualitative Study from Ethiopia

Barriers and Facilitators of Adherence to Antiretroviral Drug Therapy and Retention in Care among Adult HIV-Positive Patients: A Qualitative Study from Ethiopia

The Association of HIV-Related Stigma to HIV Medication Adherence: A Systematic Review and Synthesis of the Literature

HIV Care and Treatment Beliefs among Patients Initiating Antiretroviral Treatment (ART) in Oromia, Ethiopia

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