Barriers to adherence to antiretroviral treatment in a regional hospital in Vredenburg, Western Cape, South Africa
Abstract
BACKGROUND: South Africa currently runs the largest public antiretroviral treatment (ART)
programme in the world, with over 80% of people living with HIV and/or AIDS on ART.
However, in order to appreciate the benefits of using ART, patients are subject to
uncompromising and long-term commitments of taking at least 95% of their treatment as
prescribed. Evidence shows that this level of adherence is seldom achieved because of a
multilevel and sometimes interwoven myriad of factors.
Objective: We described the challenges faced by patients on ART in Vredenburg with regard
to ART adherence.
METHODS: A descriptive qualitative research design was used. Eighteen non-adhering patients
on ART in the Vredenburg regional hospital were purposefully selected. Using a semistructured
interview guide, we conducted in-depth interviews with the study participants in
their mother tongue (Afrikaans). The interviews were audio-taped, transcribed verbatim and
translated into English. The data were analysed manually using the thematic content analysis
method.
RESULTS: Stigma, disclosure, unemployment, lack of transport, insufficient feeding, disability
grants and alternative forms of therapy were identified as major barriers to adherence, whereas
inadequate follow-ups and lack of patient confidentiality came under major criticisms from
the patients.
CONCLUSION: Interventions to address poverty, stigma, discrimination and disclosure should be
integrated with group-based ART adherence models in Vredenburg while further quantitative
investigations should be carried out to quantify the extent to which these factors impede
adherence in the community.