Social and economic barriers to adherence among patients at Livingstone General Hospital in Zambia

Abstract

Background Zambia is one of the countries hardest hit by the human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) pandemic with a national HIV prevalence estimated at 14% among those aged 15–49 years in 2012. Antiretroviral therapy (ART) has been available in public health facilities in Zambia since 2003. By early 2016, 65% of the 1.2 million Zambians living with HIV were accessing ART. While access to ART has improved the lives of people living with HIV globally, the lack of adherence to ART is a major challenge to treatment success globally. Aim This article reports on social and economic barriers to ART adherence among HIV patients being attended to at Livingstone General Hospital in Zambia. Setting Livingstone General Hospital is located in the Southern province of Zambia, and had over 7000 patients enrolled for HIV care of whom 3880 patients were on ART. Methods An explorative, qualitative study was conducted with 42 patients on ART where data were collected through six focus group discussions (3 male and 3 female groups) and seven in-depth interviews. Data were audio-recorded and transcribed verbatim and subjected to thematic content analysis. Results Economic factors such as poverty and unemployment and the lack of food were reported as major barriers to adherence. Furthermore, social factors such as traditional medicine, religion, lack of family and partner support, and disclosure were also reported as critical barriers to adherence to ART. Conclusion Interventions to improve adherence among ART patients should aim to redress the socio-economic challenges at community and individual levels.

Adherence to HIV Antiretroviral Therapy Among Pregnant and Breastfeeding Women, Non-Pregnant Women, and Men in Burkina Faso: Nationwide Analysis 2019–2020

“…The lack of income meant that most of these people were unable to buy food or to afford transportations costs to meet their ART clinic appointment dates. 29 Our result is consistent with that of several studies. 30–32 Concerning the clinical stage at initiation, non-pregnant women who had begun ART treatment at clinical Stage 2 or more, were more likely to have poor adherence compared to those who had started at clinical Stage 1.…”

Retention in Care, Loss to Follow-up and Associated Patient Characteristics: A Retrospective Cohort Study among Adults Receiving Antiretroviral Therapy from Urban Health Facilities in Ghana

“…Regarding loss to follow-up and occupational background, the results show that employed patients (AOR 2.550, 95% CI 1.201-5.414) had higher odds of being retained in care as compared to unemployed patients who had higher LTFU of 46%. This situation is expected because unemployment has strong association with socio-economic status [18,19]. Although antiretroviral medicines could be picked by patients from their facility pharmacies of the study sites without outof-pocket payment, financial challenges associated with transportation cost of visiting ART sites have been identified in other studies among patients of our study sites.…”

Percepções acerca da qualidade de vida de pessoas vivendo com HIVaArtigo extraído da tese “Desenvolvimento de escala para avaliar a qualidade de vida de pessoas vivendo com HIV: parte 2” apresentada ao Programa de Pós-Graduação em Enfermagem Fundamental da Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo, em 2019.

“…22 Evidências de um estudo realizado na Zâmbia reforçam que pobreza e desemprego são barreiras importantes para a adesão ao tratamento antirretroviral. 23 Outro significado atribuído pelas PVHIV à QV foi o estigma vivenciado. Estudo apontou que sofrer estigma pode causar sensação de culpabilidade e inferioridade, podendo ocasionar doenças psíquicas e isolamento social.…”