Barriers to adherence to antiretroviral treatment in a regional hospital in Vredenburg, Western Cape

Magister Public Health - MPHBackground: South Africa has one of the most severe HIV epidemics globally, with an estimated 737,000 AIDS related deaths annually and over a million children rendered orphans due to AIDS in 2006. However in 2007, the South African government made a giant commitment to dealing effectively with the AIDS epidemic by implementing a National Strategic Plan (NSP), which had as one of its principal objectives the provision of antiretroviral medications to 80% of all people in need of the treatment by 2011. By the end of June 2011, the rollout of antiretroviral therapy continued to be successful with 1.4 million persons started on antiretroviral therapy and treatment initiation rates reaching 30, 000 per month. Patients have to subject to an uncompromising adherence of taking at least 95% of antiretroviral medication as prescribed, because poor adherence to ART leads to treatment failure, viral mutations and the development of drug resistance. Of major concern to ART programmes are the current obstacles that patients’ face in lieu of treatment. Aim: The aim of this study was to explore the barriers to adherence to antiretroviral treatment among patients in a public ART programme in Vredenburg, Western Cape. Methodology: An explorative qualitative study was conducted where data was collected through interviews with 18 patients receiving treatment from the Vredenburg hospital. Data was audio-tape recorded, transcribed in full and thematic content analysis done. Results: The study identified awareness of HIV status, disclosure, unemployment, lack of transport,insufficient feeding, disability grants, alcohol and alternative forms of therapy as well as stigma as major barriers to adherence. Whereas inadequate follow ups, recklessness in the way patients’ HIV results were handled, long waiting times and the fear of picking up other types of infections from other patients in the OPD also came under major criticisms from patients. Finally, the sharing of experiences at clinic visits, good healthcare provider’s patient relationships, believing in the treatment, good treatment literacy, being a parent and having children to take care of, the use of pill boxes, social and spiritual support from family members and friends were identified as factors that positively influenced adherence. Conclusion: HIV/AIDS has been a stigmatized illness since its onset in the early 1980s and, these results highlight that such stigma has yet to dissipate in Vredenburg. Therefore, stigma and disclosure must remain at the forefront of the ART programme implementation in Vredenburg; while long term projects that can support ART users economically should be created through partnerships with non-governmental organizations and the government of South Africa to optimize adherence in the community

Role of religious beliefs in adherence to antiretroviral therapy in the Cape Town metropole: A study protocol

There are presently over four million people living with HIV (PLHIV) in the South African national antiretroviral therapy (ART) programme. However, some ART programmes are battling poor ART adherence emanating from patient-related factors, including their religious beliefs. In this paper, we outline a study protocol to understand the adherence behaviours of Pentecostal Christians living with HIV to ART and to develop guidelines that can be used to strengthen ART adherence

Effectiveness, acceptability and feasibility of technology-enabled health interventions for adolescents living with HIV in low- and middle-income countries: A systematic review

Adolescents living with HIV (ALHIV) are challenged to remain adherent and engaged in HIV care. Technology-enabled interventions can be used to optimize healthcare delivery to adolescents. The largest proportion of ALHIV resides in sub-Saharan Africa. This review synthesized the evidence for the effectiveness, acceptability, and feasibility of technology-enabled health interventions for ALHIV in low and middle-income countries (LMIC). Eight electronic databases (Ebscohost, CINAHL, ERIC, MEDLINE, PubMed, SCOPUS, Science Direct, and Sabinet) and Google Scholar were searched to identify studies in LMIC published from 2010 to 2022. Quantitative and qualitative studies reporting on technology-enabled health interventions for predominantly adolescents (10–19 years) were included. The review was performed, and findings were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses Protocols

Understanding the role of religious beliefs in adherence to antiretroviral therapy among Pentecostal Christians living with HIV in sub-Saharan Africa: a scoping review

Abstract Background Optimum adherence to antiretroviral therapy (ART) is crucial in managing HIV. However, some people’s religious beliefs can influence how they deal with HIV and the psychosocial factors influencing their adherence to ART, such as disclosure, acceptance of HIV status, belief in ART, and depression. In sub-Saharan Africa (SSA), the role of religious beliefs in ART adherence is underexplored. We aimed to identify and conceptualize the literature on religious beliefs concerning ART adherence among Pentecostal Christians living with HIV in SSA. Methods We conducted a scoping review of the literature on religious beliefs and ART adherence. We searched papers from PubMed, Web of Science, Medline, Sabinet, Academic Search Complete, CINAHL Plus, Health Source/Nursing Academic, Scopus, and Google Scholar and published papers from conference proceedings and dissertations. Data were extracted according to a predetermined population, concept, context framework, and eligibility criteria for selecting or rejecting studies. We used a narrative synthesis to summarize the data on evidence and the impact of religious beliefs on ART adherence. Results Seven papers published between January 2010 and February 2022 met the inclusion criteria. Nineteen aspects of religious beliefs were identified as negatively influencing ART adherence, while eight aspects facilitated optimal adherence. “Being saved” or “born again” enhanced coping strategies for optimal adherence through actions such as less alcohol use, fidelity to a sexual partner(s), disclosure, acceptance of HIV status, reduced depression, and facilitated PLHIV to access social support from church members or other institutions. Conclusion Religious beliefs are integral to Pentecostal Christians living with HIV and affect their adherence to ART. While some Pentecostal Christians living with HIV on ART use their religious beliefs and practices to access psychosocial support from other church members or organizations and achieve good clinical outcomes, others apply their religious beliefs and practices differently and compromise their commitments to taking ART as prescribed, thus experiencing poor viral suppression and clinical outcomes. However, more research is required to understand and theorize how religious beliefs impact ART adherence among Pentecostals living with HIV to inform guidelines for practitioners