What causes non-adherence among some individuals on long term antiretroviral therapy? Experiences of individuals with poor viral suppression in Uganda

Abstract

BackgroundAntiretroviral therapy (ART) use by people living with HIV reduces HIV transmission, morbidity, mortality, and improves quality of life. Good ART adherence is required to achieve these benefits. We investigated how the environmental, social, economic and behavioural experiences of people living with HIV with poor viral suppression could explain their non-adherence to long term ART.MethodsThis qualitative cross-sectional study was conducted in Uganda between September 2015 and April 2016. Thirty individuals on ART for 5 years or more (10 on first line and 20 on second line), with poor viral suppression, were randomly selected from a cohort of people living with HIV on ART. In-depth interviews about ART; awareness, adherence counselling, obstacles to daily adherence and regimen switches were conducted. Emerging themes from the interviews transcripts and field notes were identified and thematic content analysis done. Participants’ consent, compensation, confidentiality and study ethical approvals were ensured.ResultsWe found that poor adherence to long term ART was due to: travel for work or social activities, stigma, receiving little or no continuous ART adherence education, alcohol consumption and use of alternative ‘HIV cure’ medicines. Other reasons included; ART side effects, treatment fatigue, belief that long-term ART or God can ‘cure HIV’, and food security.ConclusionsAchieving optimal ART benefits requires continuous provision of ART adherence education to individuals on long term ART. This helps them overcome the challenges related to living with HIV: worries of food insecurity, alcohol misuse, economic hardship, and beliefs in HIV cures and use of unproven alternative HIV treatments. People living with HIV who travel require adherence support and larger quantities of ART refills to cover their time away.

Treatment aspirations and attitudes towards innovative medications among people living with HIV in 25 countries

“…At the same time, medicationrelated challenges could also complicate overall treatment and adherence [7][8][9] . Other barriers to adherence include inconvenient dosing schedules, stigma, medication-related privacy concerns, emotional challenges, and polypharmacy (drug-drug interactions) [10][11][12][13] . There is therefore compelling need for flexible ART options that will meet the diversity of unmet medical, psychosocial, and emotional needs among PLHIV.…”

<p>Differential Self-Reported Determinants to Antiretroviral Therapy Adherence: Findings from Caregivers of Children Under Five Years Living with Human Immunodeficiency Virus Infection Attending Al-Sabah Hospital, South Sudan</p>

“…3 Despite the scale-up of pediatric ART programs, and proven positive attributes, ART adherence among children under-five remained sub-optimal. [9][10][11] This was as a result of many factors which hinged on the child, caregiver(s) and family, regimen, as well as the society and culture. 8 As there was limited data on ART adherence, and determining factors in South Sudan; we reported on the different caregivers' selfreported determinants of ART adherence among children under five years living with human immunodeficiency virus infection who attended Al-Sabah Hospital.…”

Treatment experienced persons living with HIV on atazanavir based second line regimens are not highly adherent to therapy: a report from a tertiary referral hospital in Kenya.

“…Alcohol use is a known determinant of non-adherence (24,26,30,32,33), though this was not identified in this study. Persons who use alcohol excessively are less likely to remember to take their medication on time or even to take them at all.…”