Treatment Adherence among Primary Care Patients in a Historically Disadvantaged Community in South Africa

Kagee, Ashraf; Roux, Marieanna Le; Dick, Judy

doi:10.1177/1359105307076232

Cited by 30 publications

(52 citation statements)

References 34 publications

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“…3 Moreover, interventions require an understanding of the social processes and cultural fabric that can create adherence differentials. 4,5 In South Africa, an estimated 50 per cent of those in need of ART receive treatment in the largest public sector treatment program (Department of Health Discussion Document, 2008).…”

Section: Introductionmentioning

confidence: 99%

Exploring antiretroviral treatment adherence in an urban setting in South Africa

Goudge

Ngoma

2011

J Public Health Pol

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Antiretroviral treatment requires high levels of adherence to be effective. This qualitative study explores the reasons for poor adherence among 22 purposively selected poor urban participants in South Africa. Over a 4-month period in 2009, we prospectively investigated experiences of HIV diagnosis and treatment, adherence, and withdrawal from treatment. Patients with no stable food sources faced significant barriers in adhering to treatment regimens and staying sufficiently healthy to search for, obtain or retain a job. The narratives also identify the influence on adherence of self-esteem and social support, vulnerability generated by ill health, gendered conflict, social inequities amplified by HIV, and exhaustion due to the social burden of the epidemic. Multi-dimensional, inter-sectoral programs that tackle the social determinants of health, such as food insecurity, poverty, gendered inequities, and treatment adherence are more likely to be successful, than single interventions to support adherence.

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Section: Introductionmentioning

confidence: 99%

Exploring antiretroviral treatment adherence in an urban setting in South Africa

Goudge

Ngoma

2011

J Public Health Pol

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“…Acyclovir is known to effectively reduce herpes symptoms (Lebrun-Vignes et al, 2007), so it is possible that some participants truly experienced fewer symptoms while taking acyclovir. Such a positive belief does not guarantee consistent, long-term adherence, particularly in settings in which people commonly believe that the disappearance of symptoms means cure (Kagee, Le Roux, & Dick, 2007;Plummer et al, 2006). Importantly, pill count adherence estimates in the trial overall were similar for acyclovir and placebo recipients (WatsonJones et al, 2008).…”

Section: Discussionmentioning

confidence: 87%

A qualitative study of participant adherence in a randomized controlled trial of herpes suppressive therapy for HIV prevention in Tanzania

et al. 2010

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Poor participant adherence to treatment may contribute to lack of impact in some biomedical HIV prevention trials. This qualitative study explored adherence in a randomized controlled trial of herpes suppressive therapy to reduce HIV acquisition and infectivity among 1305 Tanzanian women. The trial found participants completed 72% of visits on treatment; 52-56% of women on treatment had > or = 90% adherence by pill count estimate; and between six and nine months 30/86 (35%) of urine samples from acyclovir recipients tested acyclovir negative, and 7/86 (8%) from placebo recipients tested acyclovir positive. Twenty in-depth interviews (IDIs) were conducted after 30 months with respondents randomly selected from "acyclovir negative" acyclovir recipients and "acyclovir positive" placebo recipients, or by preliminary pill count adherence categories ("under users," "good users," and "over users"). Almost all respondents reported appropriate adherence and positive trial attitudes, e.g., trusting staff, appreciating services, perceiving pills as beneficial. Fourteen understood placebo use, and six understood the trial purpose. Notably, 5/9 acyclovir recipients and 1/11 placebo recipients believed their pills had treated pre-existing sexually transmitted infections. Limited understanding did not negatively affect reported adherence. Reported adherence problems usually related to illness, travel, and/or family obligations (e.g., husband's disapproval). "Acyclovir positive" placebo recipients denied taking other participants' pills. The IDIs also did not resolve discrepant reports of pill loss or theft. Biomedical HIV interventions often have strong behavioral components that require close attention during intervention development, trial design, and process and impact evaluation. This study identified topics which warrant further consideration, including: information reinforcement and comprehension assessment throughout a trial for long-term participant understanding; involving partners in adherence promotion activities; strategizing with participants to maintain adherence during familial illnesses or other crises; and close monitoring, identification, and follow-up of (1) individuals with discrepant biological tests, and (2) other sources of the treatment in the trial area. Methodological research is also needed to improve adherence measures.

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“…As displayed in the Figure, the multifaceted intervention facilitates bidirectional conversations between patients and health care providers through the IVR system. 9 The telehealth technology supports this process by providing patients with immediate feedback about home BP measurements and the opportunity to request follow-up calls from the pharmacist. Further, patients are able to see the benefits of diet, exercise, and/or medications through home BP monitoring, which reinforces the importance of these mediators to reduce BP.…”

Section: Discussionmentioning

confidence: 99%

“…8,9,[22][23][24][25][26] Previous studies have concluded that an organized system of regular follow-up, a stepped-care approach to a patient's hypertension regimen, 27 and integration of computer technology can improve BP control. 28 However, the literature lacks a model that integrates these different components into an organized system that supports patient care on multiple levels, which is the foundation of our theoretical framework.…”

Section: Discussionmentioning

confidence: 99%

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Patients' Perspectives of a Multifaceted Intervention With a Focus on Technology

Lambert-Kerzner

Havranek

Plomondon

et al. 2010

Circ: Cardiovascular Quality and Outcomes

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Background-Few studies have investigated the effectiveness of multifaceted interventions from the study participants' perspective. We conducted qualitative interviews to understand patients' experiences with a multifaceted blood pressure (BP) control intervention involving interactive voice response technology, home BP monitoring, and pharmacist-led BP management. In the randomized study, the intervention resulted in clinically significant decreases in BP. Methods and Results-We used insights generated from in-depth interviews from all study participants randomly assigned to the multifaceted intervention or usual care (nϭ146) to create a model explaining the observed improvements in health behavior and clinical outcomes. The data were analyzed using qualitative content analysis methods and consultative and reflexive team analysis. Six explanatory factors emerged from the patients' interviews: (1) improved relationships with medical personnel; (2) increased knowledge of hypertension; (3) increased participation in their health care and personal empowerment; (4) greater understanding of the impact of health behavior on BP; (5) high satisfaction with technology used in the intervention; and, for some patients, (6) increased health care utilization. Eighty-six percent of the intervention patients and 62% of the usual care patients stated that study participation had a positive effect on them. Of those expressing a positive effect, 68% (intervention) and 55% (usual care) reached their systolic BP goal. Conclusions-Establishing

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Treatment Adherence among Primary Care Patients in a Historically Disadvantaged Community in South Africa

Cited by 30 publications

References 34 publications

Exploring antiretroviral treatment adherence in an urban setting in South Africa

Exploring antiretroviral treatment adherence in an urban setting in South Africa

A qualitative study of participant adherence in a randomized controlled trial of herpes suppressive therapy for HIV prevention in Tanzania

Patients' Perspectives of a Multifaceted Intervention With a Focus on Technology

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