‘I was thinking too much’: experiences ofHIV‐positive adults with common mental disorders and poor adherence to antiretroviral therapy in Zimbabwe

Abstract

Objective To document the lived experiences of people with both poor mental health and suboptimal adherence to antiretroviral therapy in high HIV prevalence settings. Methods In-depth qualitative interviews were conducted with 47 (female =31) HIV-positive adults who scored above the cut-point on a locally-validated scale for common mental disorders. Purposive sampling was used to recruit participants with evidence of poor adherence. Six additional key informant interviews (female = 6) were conducted with healthcare workers. Data were collected and analysed inductively by an interdisciplinary coding team. Results The major challenges faced by participants were stressors (poverty, stigma, marital problems) and symptoms of common mental disorders (“thinking too much”, changes to appetite and sleep, “burdened heart”, and low energy levels). Thinking too much, which appears closely related to rumination, was the symptom with the greatest negative impact on adherence to antiretroviral therapy among HIV-positive adults with common mental disorders. In turn, thinking too much was commonly triggered by the stressors faced by people living with HIV/AIDS, especially poverty. Finally, participants desired private counselling, access to income generating activities, and family engagement in mental health care. Conclusions Better understanding of the local expression of mental disorders and of underlying stressors can inform the development of culturally sensitive interventions to reduce common mental disorders and poor adherence to antiretroviral therapy.

Patient-reported barriers and facilitators to antiretroviral adherence in sub-Saharan Africa

“…Just over half of the qualitative studies conducted semi-structured in-depth interviews (IDIs) (49; 56.3%) [17,20–22,26,27,29,32–37,39–43,45–47,49,51,54–60,62,63,65–67,69–71,78,81,84,85,87–90,95–97,165] with their HIV-positive participants. Eighteen studies (20.7%) used focus group discussions (FDGs) [19,23–25,28,50,53,61,68,73,74,76,77,82,94,98,167,169], 16 used both IDIs and FDGs (18.4%) [18,30,31,38,44,52,64,72,75,79,83,86,92,93,99,170], one used free attitude interviews (FAIs) and FGDs (1.1%) [80], one used group sessions without more detail [168], one used IDIs and life history and illness narratives [48] and one used digital stories [91].…”

Cultural adaptation of a cognitive-behavioural intervention to improve adherence to antiretroviral therapy among people living with HIV/AIDS in Zimbabwe: Nzira Itsva

“…To answer the key formative assessment questions, in a prior study (Kidia et al, 2015), we triangulated several qualitative methods (direct observation of clinicians and adherence counsellors, focus groups and in-depth interviews with key informants and with 47 clients) to gather multiple perspectives to guide implementation. Key informants were selected using purposive sampling to capture information-rich perspectives of both frontline providers of psychosocial care and supervisory staff.…”

“…Key informants were selected using purposive sampling to capture information-rich perspectives of both frontline providers of psychosocial care and supervisory staff. Methods have been presented elsewhere (Kidia et al, 2015). …”

“…Life-Steps is often delivered in a single session, with optional booster sessions, or in multiple sessions when integrated with another behavioural intervention. The barriers commonly addressed through Life-Steps, such as getting to appointments and forgetting doses, resonated with barriers perceived as important locally (Kidia et al, 2015). Other cognitive-behavioural therapy (CBT) strategies included in Life-Steps are psychoeducation, motivational interviewing and the use of reminder strategies.…”

Social Support for People Living With Acquired Immunodeficiency Syndrome

“…It is also a factor for poor treatment compliance, since the shortage of financial resources can hamper the access to health service, especially transportation means. 16 Religious belief constitutes an important part of culture, principles and values carried by patients to judge and to process information. People with HIV/AIDS perceive religious search as a source of support.…”