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

Patients\' adherence to antiretroviral therapy (ART) is important for effective medical treatment of HIV/AIDS. We conducted a qualitative interview study in the Copperbelt Province of Zambia in 2006. The aim of the study was to explore patients\' and health care professionals\' perceived barriers and facilitators to patients\' adherence to ART. Based on data from individual interviews and focus group interviews with a total of 60 patients and 12 health care professionals, we identified barriers and facilitators related to patients\' beliefs and behaviours, the health service, and socio-economic and cultural factors. Among the barriers we identified were lack of communication and information about ART, inadequate time during consultations, lack of follow-up and counselling, forgetfulness, stigma, discrimination and disclosure of HIV status, lack of confidentiality in the treatment centres, and lack of nutritional support. Feeling better, prospects of living longer, family support, information about ART, support for income-generating activities, disclosure of HIV status, prayers and transport support were among the facilitators. Our study suggests that several issues need to be considered when providing ART. Further research is needed to study interactions between patients and their health care providers. Our findings can inform interventions to improve adherence to ART. Keywords: AIDS, HIV, antiretroviral therapy, adherence, patient compliance, delivery of health care.SAHARA-J Vol. 5 (3) 2008: pp. 136-14

HIV/AIDS, Food Supplementation and Livelihood Programs in Uganda: A Way Forward?

BACKGROUND: Over the last decade, health, nutrition and policy experts have become increasingly aware of the many ways in which food insecurity and HIV infection negatively impact and reinforce one another. In response, many organizations providing HIV care began supplying food aid to clients in need. Food supplementation, however, was quickly recognized as an unsustainable and incomplete intervention. Many HIV care organizations therefore developed integrated HIV and livelihood programs (IHLPs) to target the root causes of food insecurity. METHODS AND FINDINGS: We conducted a qualitative study using in-depth interviews with 21 key informants who worked at seven organizations providing HIV care, food aid, or IHLPs in Kampala, Uganda in 2007-2008 to better understand the impact of IHLPs on the well-being of people living with HIV and AIDS (PLWHAs) and the challenges in transitioning clients from food aid to IHLPs. There was strong consensus among those interviewed that IHLPs are an important intervention in addressing food insecurity and its adverse health consequences among PLWHAs. Key informants identified three main challenges in transitioning PLWHAs from food supplementation programs to IHLPs: (1) lack of resources (2) timing of the transition and (3) logistical considerations including geography and weather. Factors seen as contributing to the success of programs included: (1) close involvement of community leaders (2) close ties with local and national government (3) diversification of IHLP activities and (4) close integration with food supplementation programs, all linked through a central program of HIV care. CONCLUSION: Health, policy and development experts should continue to strengthen IHLPs for participants in need. Further research is needed to determine when and how participants should be transitioned from food supplementation to IHLPs, and to determine how to better correlate measures of food insecurity with objective clinical outcomes so as to better evaluate program results

How Treatment Partners Help: Social Analysis of an African Adherence Support Intervention

Treatment partnering is an adherence intervention developed in sub-Saharan Africa. This paper describes the additional social functions that treatment partners serve and shows how these functions contribute to health and survival for patients with HIV/AIDS. Ninety-eight minimally structured interviews were conducted with twenty pairs of adult HIV/AIDS patients (N = 20) and treatment partners (N = 20) treated at a public HIV-care setting in Tanzania. Four social functions were identified using inductive, category construction and interpretive methods of analysis: (1) encouraging disclosure; (2) combating stigma; (3) restoring hope; and (4) reducing social difference. These functions work to restore social connections and reverse the isolating effects of HIV/AIDS, strengthening access to essential community safety nets. Besides encouraging ARV adherence, treatment partners contribute to the social health of patients. Social health as well as HIV treatment success is essential to survival for persons living with HIV/AIDS in sub-Saharan Africa

Antiretroviral treatment adherence among HIV patients in KwaZulu-Natal, South Africa

<p>Abstract</p> <p>Background</p> <p>Successful antiretroviral treatment is dependent on sustaining high rates of adherence. In the southern African context, only a handful of studies (both quantitative and qualitative) have looked at the determinants including a health behaviour theory of adherence to antiretroviral therapy. The aim of this study is to assess factors including the information, motivation and behavioural skills model (IMB) contributing to antiretroviral (ARV) adherence six months after commencing ARVs at three public hospitals in KwaZulu-Natal, South Africa.</p> <p>Methods</p> <p>Using systematic sampling, 735 HIV-positive patients were selected prior to commencing on ART from outpatient departments from three hospitals and followed-up at six months and interviewed with a questionnaire.</p> <p>Results</p> <p>A good proportion of patients were found to be adherent using both adherence instruments (visual analog scale = VAS 82.9%; Adult AIDS Clinical Trials Group = AATCG 70.8%). After adjusting for significant socio-economic variables, both the VAS and the dose, schedule and food adherence indicator found levels of adherence amongst urban residents to be almost 3 times greater than that of rural residents. After adjusting for health-related variables, for both indicators better adherence was associated with low depression and poorer adherence was associated with poor environmental factors. Adjusted odds ratios for adherence when taking into account different behavioural variables were for both adherence indicators, discrimination experiences were associated with lower adherence, and higher scores in adherence information and behavioural skills were associated with higher adherence. For the VAS adherence indicator, higher social support scores were associated with higher adherence. For the dose, schedule and food adherence indicator, using herbal medicines for HIV was associated with lower adherence.</p> <p>Conclusion</p> <p>For the patients in this study, particularly those not living in urban areas, additional support may be needed to ensure patients are able to attend appointments or obtain their medications more easily. Adherence information and behavioural skills as part of the IMB model should be strengthened to improve adherence. Further psychological support is also required and patients' perceived need for ARTs should be routinely assessed.</p

Knowledge and Perception of Sexual Harassment in an Institution of Higher Education in Sub-Saharan Africa

Objective: To find out if Sexual Harassment existed at a higher institute of learning and explore perception of sexual harassment in the university community and to make recommendations based on the findings.Methodology: This was a cross sectional study that collected both primary and secondary data. The participants included 913 students, 90 academic staff and97 non-academic staff who were selected from within the university community. Questionnaires were administered in class for the students and individually with staff members after obtaining informed consent. Secondary data records from 1996 to 2006 on issues to do with sexual harassment from Registrar's department, Deans of students, counselling center, at the university clinic and records from staff and students were collected.Results: The study found that the majority of the participant (54.1%) knew what  sexual harassment was. It was Further found that Fifty seven (57%) of the respondents acknowledged that Sexual Harassment does occur at the university with more females indicating the occurrence of Sexual harassment acts. There washowever a discrepancy in the understanding of what constitutes sexual harassment with the students being the least to identify sexual harassment acts. The study alsorevealed that that more female; students and nonacademic staff identified more  forms of sexual harassment acts and behaviour than the male participants.Conclusion: It could be concluded that Sexual harassment may be a problem at the university. However, despite the varying responses on perceptions of the occurrence of sexual harassment, a university sexual harassment policy should be formulated and implemented at the university in order to deter the would be harassers and protect the potential victi

Exploring factors associated with ART adherence and retention in care under Option B+ strategy in Malawi: A qualitative study

Although several studies have documented challenges related to inadequate adherence to antiretroviral therapy (ART) and high loss to follow-up (LTFU) among Option B+ women, there is limited understanding of why these challenges occur and how to address them. This qualitative study examines women's experiences with ART adherence and retention in care. Between July and October 2015, in-depth interviews were conducted with 39 pregnant and lactating women who initiated ART at Bwaila Hospital in Lilongwe, Malawi. Study participants included 14 in care and 25 out of care women, according to facility records. Data were analyzed using an inductive, open-coding approach to thematic analysis. Ten of the respondents (7 out of care, 3 in-care) had stopped and re-started treatment before the interview date. One of the most important factors influencing adherence and retention was the strength of women's support systems. In contrast to women in-care, most out-of-care women lacked emotional and financial support from male partners, received minimal counseling from providers at initiation, lacked designated guardians to assist with medication refills or clinic appointments, and were highly mobile. Mobility led to difficulties in accessing treatment in new settings. The most common reasons women re-started treatment following interruptions were due to providers' counseling and encouragement and the mother's desire to be healthy. Improved counseling at initiation, active follow-up counseling, women's economic empowerment interventions, promotion of peer counseling schemes and meaningful engagement of male partners can help in addressing the identified barriers and promoting sustained retention of Option B+ women