Perceived adherence barriers among patients failing second-line antiretroviral therapy in Khayelitsha, South Africa

Abstract

Background. The recent scale-up of antiretroviral therapy (ART) coverage in resource-limited settings has greatly improved access to treatment. However, increasing numbers of patients are failing first- and second-line ART.Objective. To examine factors affecting adherence to second-line ART from the perspective of clinic staff and patients, assessing both individual and structural perceived barriers.Methods. Research was conducted at a large primary care tuberculosis (TB)/HIV clinic in Khayelitsha, a peri-urban township in Cape Town, South Africa. Participants were drawn from a Médecins Sans Frontières-run programme to support patients failing second-line ART. A qualitative research approach was used, combining multiple methodologies including key informant interviews with staff (n=11), in-depth interviews with patients (n=10) and a Photovoice workshop (n=11). Responses and photographs were coded by content; data were transformed into variables and analysed accordingly.Results. Staff identified drinking, non-disclosure, not using condoms and pill fatigue as barriers to ART adherence, while patients identified side-effects, not using condoms and a lack of understanding concerning medication timing. With respect to service delivery, staff identified a need for continued counselling and educational support following ART initiation. Patients were concerned about missing medical records and poor staff attitudes in the clinic.Conclusion. These findings identify discrepancies between provider and patient perceptions of barriers to, and facilitators of adherence, as well as of service delivery solutions. This highlights the need for on-going counselling and education following ART initiation, improved quality of counselling, and improved methods to identify and address specific barriers concerning medication adherence.

The Role of ARV Associated Adverse Drug Reactions in Influencing Adherence Among HIV-Infected Individuals: A Systematic Review and Qualitative Meta-Synthesis

“…Thirty-three out of 39 studies reported that perceived adverse ARV reactions decreased adherence [12, 15–46], whilst six studies [47–52] described no apparent relationship. Nineteen studies [12, 15–27, 29, 32, 36, 44, 47] were conducted in high-income countries, eight [30, 31, 33, 34, 41, 42, 46, 49] in middle-income countries, and twelve [28, 35, 37–40, 43, 45, 48, 50–52] in low-income countries. (Countries—see Tables 1, 2).…”

A quantitative analysis of food insecurity and other barriers associated with ART nonadherence among women in rural communities of Eswatini

“…Facing extreme poverty and hunger on a daily basis while trying to cope with the complex health issues associated with HIV could understandably increase stress levels. Studies indicate that when people are stressed they are more likely to drink, and consequently, forget to take their medication [ 45 , 46 ]. Our study revealed forgetfulness to be a significant barrier to ART adherence.…”

Understanding adherence in virally suppressed and unsuppressed human immunodeficiency virus-positive urban patients on second-line antiretroviral treatment

“…Furthermore, the participants suggested that education on the benefits of taking ART could improve adherence, whilst a few participants also suggested the implementation of injectable ART. Various studies have recommended similar strategies, 49,50,51 with the effectiveness of some of these strategies being previously reported for first-line regimens. 51,52…”