HIV and tuberculosis in Durban, South Africa: adherence to two medication regimens

Abstract

Given that antiretroviral (ARV) medication adherence has been shown to be high in resource-limited countries, the question remains as to whether adherence will remain at that level as medications become more widely available. Comparing adherence to tuberculosis (TB) medications, which have been readily available, and ARV medications may help to indicate the likely future adherence to ARVs as access to these medications becomes more widespread. This study examined sense of coherence, social support, symptom status, quality of life, and adherence to medications in two samples of individuals being treated either for TB or human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) at clinics in Durban, South Africa. Findings revealed the distinctive socio-economic backgrounds of the two cohorts. Although there were significant differences with regard to the psychosocial variables, there were no significant differences by the two samples in adherence to medications as well as adherence to appointments. Given the self-selected nature of the participants in this study, namely those able to attend clinic, as well as those likely to be adherent to ARVs, there is every reason for caution in the interpretations of these findings. As access to ARV medications becomes more widely available in South Africa, the question remains as to whether such high adherence will be maintained given the constraints of access to food and other basic necessities.

Interventions to increase antiretroviral adherence in sub-Saharan Africa: a systematic review of evaluation studies

“…These interventions included treatment supporters providing both emotional and instrumental adherence support. 66-69, 71, 77, 78, 84, 87 One study combined behavioural, cognitive, affective, and biological interventions through combinations of treatment supporters, nutritional support, financial support, psychosocial support, and education sessions. 72 Purely behavioural interventions used directly observed therapy, 60, 63, 64 diary cards, 82 and cell phone short message services (SMS) to remind patients to take their ART medication.…”

Preferential adherence to antiretroviral therapy over tuberculosis treatment: A qualitative study of drug-resistant TB/HIV co-infected patients in South Africa

“…Together with regimen complexity, pill burden and adverse effects, non–adherence to MDR– and XDR–TB treatment was additionally tied to poor perceived treatment outcomes, social isolation, stigmatisation, and inadequate attention to patient education and support. Indeed, in a recent study comparing treatment experiences of patients receiving treatment for either TB or HIV, patients on TB treatment reported lower scores related to quality of life, social belonging, social support, and symptom control (Corless et al, 2009). …”

Predictors of tuberculosis (TB) and antiretroviral (ARV) medication non-adherence in public primary care patients in South Africa: a cross sectional study

“…Numerous studies have also been conducted in Africa and globally on factors influencing adherence to anti-TB treatment and adherence to the dual treatment approach for TB and HIV [2,10,11]. A systematic review of qualitative research, exploring patient adherence to tuberculosis treatment, conducted by Munro et al found that the following four factors interact to affect adherence to TB treatment: structural factors, including poverty and gender discrimination; the social context; health service factors and personal factors [5].…”

“…The factors influencing adherence were clinic facilities, treatment characteristics and patient factors although the association between adherence and these factors was found to be inconsistent [12]. Adherence to ARVs as compared to anti-TB drugs is, however, reported to be high the world over and Corless et al based a quantitative study conducted in clinics in Durban, SA, on this premise [10]. They found that in fact adherence to ARVs in their study was also high [10].…”