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AIDS Care
Psychological and Socio-medical Aspects of AIDS/HIV
Volume 27, 2015 - Issue 3
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Original Articles

Barriers and facilitators to paediatric adherence to antiretroviral therapy in rural South Africa: a multi-stakeholder perspective

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Pages 315-321 | Received 17 Mar 2014, Accepted 15 Sep 2014, Published online: 30 Oct 2014
 

Abstract

Poor adherence to antiretroviral therapy (ART) contributes to the development of drug resistance. HIV-infected children, especially those 5 years and under, are dependent on a caregiver to adhere to ART. However, characteristics of the caregiver, child, regimen, clinic and social context affect clinic attendance and medication-taking, both of which constitute adherent behaviour. We conducted nine interviews and three focus groups to determine how doctors, nurses, counsellors, traditional healers and caregivers understood the barriers and facilitators to ART adherence among children residing in rural South Africa. The data were transcribed, translated into English from isiZulu where necessary, and coded using Atlas.ti version 7. Results were interpreted through the lens of Bronfenbrenner's Ecological Systems Theory. We found that at the micro-level, palatability of medication and large volumes of medication were problematic for young children. Characteristics of the caregiver including absent mothers, grandmothers as caregivers and denial of HIV amongst fathers were themes related to the micro-system. Language barriers and inconsistent attendance of caregivers to monthly clinic visits were factors affecting adherence in the meso-system. Adherence counselling and training were the most problematic features in the exo-system. In the macro-system, the effects of food insecurity and the controversy surrounding the use of traditional medicines were most salient. Increased supervision and regular training amongst lay adherence counsellors are needed, as well as regular monitoring of the persons attending the clinic on the child's behalf.

Acknowledgements

We would like to thank all the participants who took part in this research, and all those that helped to set up and facilitate the interviews and FGs.

Additional information

Funding

Funding from the Columbia University-Southern African Fogarty AIDS International Training and Research Program (AITRP) funded by the Fogarty International Centre, National Institutes of Health [grant number D43TW00231] and the US President's Emergency Plan for AIDS Relief through HRSA via MEPI are gratefully acknowledged. The Africa Centre is funded by the Wellcome Trust, UK [grant number 097410/Z/11/Z].