Developing a management framework for predicting adherence to HIV care and treatment in Eswatini

Abstract

The primary objective of this research was to develop a management framework for predicting adherence to HIV care and treatment in Eswatini. To achieve this goal, the study delved into the comprehension of adherence to HIV care and treatment among people living with HIV/AIDS (PLHIV); identified psychological factors influencing adherence to HIV care and treatment; evaluated Theory of Planned Behavior (TPB)- based indicators to assess their effectiveness in predicting adherence behaviour to HIV care and treatment before commencing antiretroviral therapy (ART); and validated the applicability of the TPB in predicting adherence to HIV care and treatment. The study employed a sequential exploratory mixed methods approach in its research methodology. An initial qualitative study was conducted to explore the adherence beliefs of newly diagnosed PLHIV towards HIV care and treatment. The process involved gathering qualitative data on the beliefs of 19 recently diagnosed HIV-positive patients from a local HIV Clinic in Manzini, Eswatini. A thematic analysis revealed 226 beliefs, which were then condensed into 45 themes to establish the final set of significant beliefs categorised under TPB precursors: behavioural outcomes, subjective standards, and perceived behavioural control. The results of this qualitative study played a crucial role when constructing the TPB questionnaire, as the data gathered from the study were used as variables in creating the questionnaire. The TPB questionnaire, derived from the qualitative research, was distributed to 152 participants as part of the main quantitative study. This investigation unveiled the complex interplay between individuals' perceptions of social norms, attitudes, and perceived behavioural control in shaping their adherence to HIV care and treatment. While the opinions of influential figures in participants' lives were significant, the study found that participants' personal beliefs and attitudes towards adherence had a more substantial influence. During a span of 12 months, the 152 participants were closely observed, and their adherence to HIV care and treatment was assessed at baseline and endline points to evaluate the predictive validity of the TPB measure. The analysis of the collected data revealed that, despite participants appearing to adhere to their medication regimen iv based on clinic visits and self-reported pill usage, their viral loads remained detectable. This study underscored the drawbacks of solely relying on self-reported data and emphasized the necessity of employing alternative approaches to accurately assess levels of adherence. The study revealed limitations in the application of the TPB in addressing adherence to HIV care and treatment in developing nations with socioeconomic challenges. The original TPB model mainly concentrates on predicting and explaining behavioural intentions but overlooks the objective evaluation of the observed behaviour. When assessing adherence to HIV treatment, it is crucial to analyse the effectiveness of the behaviour being observed to identify the elements that lead to good adherence. This research suggests expanding the existing TPB model to overcome its limitations by including factors other than observable behaviour. A conceptual management framework for HIV care and treatment based on the TPB was developed to overcome the shortcomings of the TPB in predicting adherence to HIV care and treatment in underdeveloped countries. Four crucial additions were incorporated: (1) an enhanced behavioural intention (2) developmental challenges driven by socio-economic factors (3) subjective confirmation regarding the behavioural action, and (4) behavioural validation of the behavioural action. In addition to various aspects, it recommended that the conceptual framework developed by this study to manage HIV/AIDS care and treatment based on the TPB should undergo a validation process before its implementation with the aim of validating its effectiveness.