Treatment Supporter to Improve Adherence to Antiretroviral Therapy in HIV-Infected South African Adults

Abstract

Little is known about the patient characteristics, social support networks, and relationship factors associated with excellent adherence in resource-limited settings, even though these can be important clues that inform the identification of targets and the approaches of individual- and community-based antiretroviral therapy adherence interventions. In this study, we aimed to understand how patient-selected treatment supports might affect antiretroviral treatment outcomes and to identify key components of support, including the social and material resources necessary for promoting high adherence in South Africa. Data were collected from the proceedings of 2 focus groups with 6 HIV-infected adults each and from 7 in-depth interviews with health care providers in the Western Cape Province of South Africa. The patients and health care workers identified individuals-usually a mother, daughter, sister, brother, or partner-who were confidantes and had moral authority with them. These individuals command respect, and patients allow them to influence health-related decision making, both of which are necessary if they are to be effective treatment supporters. Barriers to adherence identified by study participants include alcohol abuse, stigma related to disclosure of HIV status, and lack of financial resources and food. These are critically important challenges to address if high adherence is to be achieved in this setting. In addition, our results suggest that interventions tailored to treatment supporter characteristics and relationship factors may be effective in influencing patients' antiretroviral therapy adherence.

Barriers and facilitators to patients' adherence to antiretroviral treatment in Zambia: a qualitative study

“…Stigma and social exclusion has also been highlighted in other studies as a barrier to adherence to ART (Kumarasamy et al, 2005). Fear of disclosure of HIV/AIDS status or being seen taking medication was identified as a barrier to adherence in previous studies (Mills, Nachega, Bangsberg et al, 2006;Nachega et al, 2006), and this was also mentioned by one group of patients in our study. For others, however, disclosure was reported as a facilitator to adherence.…”

“…However, most health facilities did not provide nutritional support to their patients on ART. Lack of food has been identified before in some studies as a factor responsible for patients defaulting from their treatments (Hardon et al, 2007;Nachega et al, 2006).…”

“…However, among the 37 qualitative studies included in the review, only two were from developing countries, thus the authors concluded that 'Research is urgently needed to determine patient-important factors for adherence in developing world settings. ' Several reports have been published since then from qualitative studies exploring factors that may affect adherence to ART (Hardon, Akurut, Comoro, Ekezie, Irunde & Gerrits et al, 2007;Kumarasamy, Safren, Raminani, Pickard, James, Krishnan et al, 2005;Malta, Petersen, Clair, Freitas & Bastos, 2005;Nachega, Knowlton, Deluca, Schoeman, Waltkinson, Efron et al, 2006). In an open cohort study of more than 16 000 adult patients that were started on ART in urban Zambia (Lusaka), poor adherence was among the factors found to be strongly correlated with mortality (Stringer, Zulu, Levy, Stinger, Mwango, Chi et al, 2006).…”

The Enabling Effect of Food Assistance in Improving Adherence and/or Treatment Completion for Antiretroviral Therapy and Tuberculosis Treatment: A Literature Review

“…Food insecurity is one of the multiple barriers that individuals face in initiating and adhering to long-term medical therapies such as ART and DOTS, especially in resourcelimited settings [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]. Other patient-related barriers include the complexity of the medication regimen [18], emotional distress [7], illness costs to households [19], stigma [20], health beliefs and poverty [4], limited knowledge of the disease [21], difficulty remembering [22], intentional non-adherence due to adverse drug reactions [23] and harmful use of alcohol [24].…”

Perceived stigma among patients receiving antiretroviral treatment: A prospective randomised trial comparing an m-DOT strategy with standard-of- care in Kenya

“…Several strategies have been utilised to optimise adherence, for example: self-efficacy building, medication management skills, patient education and use of treatment buddies (Ickovics & Meade, 2002;Nachega et al, 2006;Remien et al, 2005;Sabin et al, in press;Safren, Hendriksen, Desousa, Boswell, & Mayer, 2003 Tuldra et al, 2000;Weber et al, 2004;Wong, Lawrence, Struthers, McIntyre, & Friedland, 2006). These strategies have mainly been evaluated in high-income countries.…”