Social support, disclosure and stigma and the association with non-adherence in the six months after antiretroviral therapy initiation among a cohort of HIV-positive adults in rural KwaZulu-Natal, South Africa^*

* NM was PI of the original prospective cohort study that provided data for this secondary data analysis. NM and SG conceived the data analysis plan and conducted the analyses. SG wrote the first draft and both authors contributed to finalising the manuscript.

ABSTRACT

The World Health Organisation (WHO) recommends antiretroviral treatment (ART) initiation at human immunodeficiency virus (HIV) diagnosis. As ART programmes expand, addressing barriers to adherence is vital. Past mixed findings on the association between social support, stigma and non-disclosure with ART adherence highlights the need for further research. The primary aim of this study was to examine how these factors are associated with ART non-adherence in the six months after ART initiation. The secondary aim was to explore how other factors are associated with non-adherence. We conducted secondary analysis of prospective data from HIV-positive adults initiating ART. Social support, disclosure patterns, perceived stigma and other demographic factors were collected at ART initiation and six months follow-up. Logistic regression models were used to examine factors associated with self-reported ART non-adherence in the last six months and the last month before the six month follow-up (“recent”). Non-adherence in the last six months was twenty-five percent and recent non-adherence was nine percent. There was no association between non-adherence and social support, stigma or non-disclosure of HIV status. In the final model the odds of non-adherence in the last six months were significantly higher for those: with incomplete ART knowledge (aOR 2.10, 95%CI 1.21–3.66); who visited a healthcare provider for conditions other than HIV (aOR1.98, 95%CI 1.14–3.43); had higher CD4 counts at ART initiation (CD4 100–199:aOR 2.50, 95%CI 1.30–4.81; CD4 ≥ 200:aOR 2.85, 95%CI 1.10–7.40;referent CD4 < 100 cells/mm³); had tested HIV-positive in the last year (aOR 2.00, 95%CI 1.10–3.72; referent testing HIV-positive outside the last year); experienced a rash/itching secondary to ART (aOR 2.48, 95%CI 1.37–4.52); and significantly lower for those ≥48 years (aOR 0.65, 95%CI 0.46–0.90). Early non-adherence remains a concern. Incorporation of adherence monitoring and ART knowledge enhancement into appointments for ART collection may be beneficial.

KEYWORDS:

• HIV
• antiretroviral therapy
• non-adherence
• South Africa
• social support

Acknowledgements

The Henry Trotter Charity funded SG. The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report.

Disclosure statement

No potential conflict of interest was reported by the authors.

Data Availability

The analytical dataset for this study is available through request to the Africa Health Research Institute data repository (https://data.africacentre.ac.za).

Notes

* NM was PI of the original prospective cohort study that provided data for this secondary data analysis. NM and SG conceived the data analysis plan and conducted the analyses. SG wrote the first draft and both authors contributed to finalising the manuscript.

Additional information

Funding

NM and data collection of the prospective cohort study that provided data for this secondary data analysis were supported by Wellcome Trust [grant number #WT083495MA].