The Impact of Formal and Informal Institutions on ART Drug Adherence

Abstract

A successful antiretroviral therapy (ART) drug adherence is achieved when patients follow their prescribed regimen. This is determined by patient’s motivation that is influenced by resources associated with the patient, society, and relevant institutions. The aim of this study is to assess the impact of formal and informal actors on patients’ ART drug adherence. A qualitative study approach was conducted through face-to-face in-depth interviews of HIV-infected patients and key informants. The analysis was guided by a salutogenic model focusing on generalized resistance resources and a sense of coherence. The finding shows that 76% of the study participants achieved the recommended 95% adherence level. Several resources attributed to individuals, society, and public institutions influencing patients’ day-to-day life and their drug adherence were identified. Patients who are able to use the available resources easily develop sense of coherence and follow their prescribed drug regimen. Therefore, encouraging HIV-infected patients through formal and informal actors can enhance ART drug adherence.

Social Networks and Barriers to ART Adherence Among Young Adults (18–24 years) Living with HIV at Selected Primary Health Facilities of South-Western Uganda: A Qualitative Study

“…This finding agrees with the literature from Ethiopia, Uganda, Kenya, Zimbabwe, and Mozambique, about adults and youth with HIV where again family and friends provided among others, food, money, encouragement and love, and reminders that helped them overcome multiple barriers to ART adherence. 27,67,71,72,75 Consistent with findings from the USA and South Africa among adult and older patients (50+) with HIV [47,68], this study also found that bonding networks, particularly family members, were also key in protecting some of YALWH against stigma and also helped them cope with HIV.…”

“…Likewise, bridging networks of adults with HIV in Ethiopia and Zimbabwe mainly comprised non-formal (indigenous community initiated) groups and rarely formal groups (linked/facilitated by governmental and non-governmental organizations). 67,68,71 This study demonstrates that non-formal community groups may play a supportive role to YALWH on ART in places where formal community groups are scarce, like in Sub-Saharan Africa. 24 Like in a previous study, 23 peer support groups were also found to help YALWH to live positively and come to terms with the HIV disease.…”

“…This finding corroborates findings in Ethiopia, Mozambique, and Zimbabwe where non-formal groups were a key source of financial, nutritional, and psychosocial support among many others. 67,68,[71][72][73][74] However, fewer participants of this study thought that bridging and bonding networks had a role in overcoming health system-related barriers. This was partly because of the inability to disclose health system-related barriers to their networks, second to a perception that they would do nothing to change them.…”

“…Our findings are similar to those of other studies conducted in Brazil, Zambia, and Kenya among adults (>18 years) with HIV, where again friends and family and not neighbors were the dominant forms of social networks. 27,71,73,75 However, in the USA, social networks of older adults with HIV (50+yrs) were mostly composed of smaller (fragile) networks of older friends (often living with HIV), whom they relied on than family members for support. [43][44][45][46] Previous literature on HIV indicates that women were more likely to care for PLWH than men.…”

Healthcare Providers’ Perspectives and Role in Improving Patient Engagement in HIV Treatment and Care in Almaty, Kazakhstan

“…Evidence from meta-analyses and systematic reviews show that psychosocial interventions are an effective approach to improving ART adherence [12]. Formal and informal institutions play important roles in improving HIV treatment adherence [13]. Our study results are important for developing and adapting a clinic-based intervention that focuses on provider-patient communication.…”