Treatment adherence following national antiretroviral rollout in South Africa

Abstract

The national antiretroviral (ARV) programme in South Africa commenced in 2004. ARV drugs became readily available to all South Africans due to the concerted efforts of ‘access to all’ campaigns. This study investigates medication adherence among a sample of South Africans after the ARV rollout in order to gain insight into the adherence challenges they face. A semi-structured questionnaire was completed by 439 participants from across the country. The results show that only 40% of the respondents were able to reach the optimum adherence level of 90% or above. The patients who displayed below-optimum adherence often had not been part of an ARV-preparation programme, did not have HIV-treatment supporters, lacked general knowledge about drug adherence, and felt unsupported by healthcare providers in their day-to-day effort to adhere to their medications. They often had no money for food or transportation, ran out of ARVs for various reasons, suffered from HIV-treatment fatigue, battled with depression, abused alcohol, could not disclose to sexual partners that they were on ARVs, and often had to hide or skip ARV dosages because they feared stigma and discrimination. Suggestions to assist patients to adhere to their ARV medications are made.

Keywords:

• ARV adherence
• disclosure
• drug compliance
• drug resistance
• medical services
• public health sector
• national programmes
• self-reporting

Notes

1 A letter explaining the purpose of the research was presented to the management of the clinic/hospital, and written consent was requested from management as well as from the patients filling in the questionnaire.

2 According to the Panel on Guidelines for the Use of Antiretroviral Agents for Adults and Adolescents (2009, p. 111), “When ascertained in a simple, nonjudgmental, routine, and structural format that normalizes less-than-perfect adherence and minimises socially desirable responses, patient self-report remains the most useful method for the assessment and longitudinal monitoring of a patients’ adherence in the clinical setting.”

3 The factorability of the correlation matrix was supported by a Kaiser-Meyer-Oklin value of 0.86 (exceeding the recommended value of 0.6) (Kaiser, 1974) and statistical significance (p ≤ 0.0001) was reached on Bartlett's test of sphericity (Bartlett, 1954).

4 The results of this section are presented in Table 3.

5 See Table 4 for the number of participants who experienced the various barriers discussed in this section.

6 To simplify reporting, the p-values are based on the differences between the optimum-adherence group, on the one hand, and the two default groups, on the other hand.