Key barriers to antiretroviral (ARV) treatment adherence : Experiences of health care workers (HCW) and antiretroviral therapy (ART) clients in the uThukela district of KwaZulu-Natal.

Abstract

In the fight against HIV and AIDS, the world managed to put more than 17 million people on anti-retroviral treatment (ART) in 2016. More than three million of the people on ART are in South Africa, and more than one million of them are in KwaZulu-Natal. South Africa is the epicentre of HIV and AIDS and has adopted the United Nations’ (UN) 90 90 90 strategy to end AIDS and the World Health Organization’s (WHO) Universal Test and Treat Policy for people living with HIV. All this could be challenged by the level of adherence to treatment by the individuals put on antiretroviral (ARVs). This study sought to identify barriers to adherence for people using ARVs in a rural area in South Africa. The main aim of this study was to identify key barriers that make HIV-positive people who are using ARVs fail on ART. In total, 14 research participants were purposefully sampled and interviewed using semi-structured questions. Of the 14 research participants, five were clients who are on ARVs (two men and three women), three facility lay counsellors, three facility community care givers (CCGs) and three Nurse Initiated and Management of Antiretroviral Therapy (NIMART) nurses. Data from interviews were analysed using thematic analysis to identify barriers to adherence for ART. In this study, 12 barriers to adherence for Injisuthi clients who were using ARVs were identified. The barriers identified included: 1) side effects, 2) pill burden, 3) no improvement while on ART, 4) use of alternative (traditional) medicine, 5) improved health, 6) communication with health care workers, 7) practical problems/socio-economic issues (poverty), 8) mobility and migration labour, 9) gender and social organisation (masculinity), 10) stigma and discrimination leading to fear of disclosure, 11) lack of community support, and 12) service delivery. In the rural context, it is critical for improved adherence to ART to establish interventions that tackle socio-economic, stigma and gender issues, together with providing appropriate continuous psychosocial support for clients using ARVs when they complain about side effects and pill burden.