Facilitators and barriers to antiretroviral therapy adherence among adolescents and young adults in rural South Africa

Abstract

Background: South Africa’s antiretroviral therapy (ART) programme is regarded as one of biggest in the world, to combat the effects of Human Immunodeficiency Virus (HIV) and Acquired Immuno-deficiency Syndrome (Aids) among infected and affected rural communities. The notable challenge on the programme was related to the sub-optimal adherence to ART among vulnerable groups including adolescents and young adults (AYA), who remained viral unsuppressed despite being on ART. The available literature has made recommendations for future research studies to explore factors hindering adherence to ART to adolescents and young adults living in rural areas. Aims: To explore multi-level facilitators and barriers to ART adherence among AYA living with HIV/Aids in rural South Africa. Methodology: A cross-sectional study using a qualitative approach was used to explore the phenomenon. A convenient sampling method was employed to recruit a maximum of 20 participants or until data saturation was reached. Data was collected through in-depth interviews using audio recorder tape lasting about 25-45 minutes per session, which were transcribed verbatim. Thematic analysis using deductive and inductive approaches was used to analyse data and interpret the research study findings or results. As an Operational Manager at Othobothini Community Health Centre, I approached this study with insider knowledge of the healthcare system, while using reflexive and participant-centred strategies to minimise bias and ensure that the voices of adolescents and young adults living with HIV/AIDS remained central to the research. Findings: The most evident experiences explored in the study relating to ART adherence barriers from intrapersonal to structural level were medication related side effects and lack of autonomy, non-disclosure of HIV status, stigma and discrimination, overarching priorities, and lastly, adolescence stage largely influenced the ability to efficient adhere to ART among targeted groups. The common facilitators explored among AYA from intrapersonal to structural level were fear of getting sick or death, family support system, normalisation and shared experiences, positive attitude of healthcare workers, and lastly, technology innovation such as manual and digital reminders played a significant role in promoting optimal ART adherence. iii Conclusion: Facilitators and barriers to ART adherence have several sources of origin, some are health system and process induced. Therefore, creating an environment enabling full disclosure, maintaining healthcare worker professionalism, and demand creation for HIV information can help eradicate stigma related factors. Furthermore, multisectoral stakeholders need collaboration to strengthen adherence counselling, family support, education, and continuous supervision at homes.