Adherence-monitoring practices by private healthcare sector doctors managing HIV and AIDS patients in the eThekwini metro of KwaZulu-Natal.
Jinabhai, Champaklal Chhaganlal.
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Background: The danger of poor adherence to treatment by patients with HIV infection is that poor adherence correlates with clinical and virological failure. Understanding how private-sector doctors monitor adherence by their HIV-infected patients could assist in developing interventions to improve adherence by these patients. Information about such practices amongst private-sector doctors in the province of KwaZulu-Natal, however, is limited. This study was, therefore, undertaken to assess the private-sector doctor adherence-monitoring practices of HIV-infected patients in the eThekwini metro of KwaZulu-Natal. Methods: A descriptive cross-sectional study was undertaken amongst private general practitioners (GPs) and specialists managing HIV/AIDS patients in the eThekwini metro. Anonymous semi-structured questionnaires were used to investigate adherence-monitoring practices by these doctors and their strategies to improve adherence. Results: A total of 171 doctors responded, with over 75% in practice for over 11 years and 78.9% indicating that they monitored adherence. A comparison between the GPs and the specialists found that 82.6% of the GPs monitored adherence compared with 63.6% of the specialists (p = 0.016). The doctors used several approaches, with 60.6% reporting the use of patient self-reports and 18.3% reporting the use of pill counts. A total of 68.7% of the doctors indicated that their adherence monitoring was reliable, whilst 19.7% indicated that they did not test the reliability of their monitoring tools. The most common strategy used to improve adherence by their patients was through counselling. Other strategies included alarm clocks, SMSs, telephone calls to the patients, the encouragement of family support and the use of medical aid programmes. Conclusions: Private-sector doctors managing HIV/AIDS patients in the eThekwini metro of KwaZulu-Natal do monitor adherence and employ strategies to improve adherence.