Barriers and facilitators to antiretroviral therapy adherence: a patient and health -care provider perspective

Abstract

HIV/AIDS remains a global pandemic that is affecting millions of people. The advent of antiretroviral medication in the late 1980s has led to major advances in clinical treatment that has turned the deadly disease into a chronic condition for those who are infected. However, adherence to antiretroviral medication remains problematic. Whilst extensive international research has been done to identify various variables that contribute to rates of non-adherence, there is not much research being done in South Africa that provides a reliable prediction of non-adherence or generates a theoretical understanding of the issue. The main aim of this study was to ascertain the barriers and facilitators that contribute to the level of adherence to antiretroviral treatment. This was done from a biopsychosocial perspective that takes into account not only the biomedical factors that may have an impact on antiretroviral treatment levels but also includes the various psychological and socio-political factors that contribute to non-adherence. The qualitative research methodology was used. Data was collected from 14 participants using semi-structured interviews. The participants included 3 medical practitioners, 1 nutritionist, 2 counsellors, 2 treatment activist, 2 caregivers to PLWHA and 4 people on treatment. Interviews were audio-recorded and transcribed. Thematic content analysis was used to generate themes. Themes were categorised under individual, interpersonal level and systemic level barriers and facilitators to ARV treatment which included biomedical, psychological as well as social-political factors that facilitate non-adherence. The main findings in this study suggest that there is a complex web of interaction between the various biomedical, psychological and socio-political factors that impact on adherence levels. Additionally, the response by PLWHA to their illness and subsequently to ARV treatment is more complex than a mere conforming to a set of medical standards and instructions. As such intervention that looks to increase adherence levels cannot be a one-dimensional or onesided endeavour and requires a multifaceted approach.