Looking at antiretroviral adherence through a disability lens: a cross-sectional analysis of the intersection of disability, adherence, and health status

Abstract

Background: Antiretroviral adherence is vital to the successful long-term rollout of the antiretroviral therapy program in South Africa. At present, there are no studies that look at the effects of disability on antiretroviral adherence.

Methods: Drawing on the baseline data from an existing cohort of 1042 people on antiretrovirals in a public healthcare setting in KwaZulu-Natal, the paper investigated a variety of existing covariates relating to antiretroviral adherence, together with functional limitations, depressive symptoms, and health symptoms. Disability was defined according to the International Classification of Functioning, Disability, and Health framework and measured using the World Health Organization Disability Assessment Schedule.

Results: In a proportional odds logistic regression functional limitations, depressive symptoms, health symptoms and gender emerged as significant associated with decreased adherence to antiretrovirals (Odds ratio [95% confidence interval]: 1.86 [1.31, 2.66], 1.61 [1.02, 2.55], 2.33 [1.47, 3.69], and 1.65 [1.16, 2.35], respectively). This was found for both severe and milder forms of functional limitations/disability.

Conclusion: The paper highlights the need to better understand the role of these limitations in achieving adequate adherence to antiretrovirals and viral suppression. It also calls for investigations into integrated mitigating services such as integrating rehabilitation into routine human immunodeficiency virus care.

Implications for Rehabilitation

• This study provides a starting point to understand the association between functional limitations and challenges in maintaining adherence to antiretroviral therapy.

• Addressing functional limitations is currently a neglected factor in efforts targeting HIV-treatment adherence and retention.

• Rehabilitation is a key intervention that could address this gap.

• Even mild forms of disability can have profound effects on adherence to antiretroviral therapy, which highlights the need for better screening, early identification, and referrals to rehabilitative support and treatment

Keywords:

• HIV
• ART
• adherence
• disability
• mental health

Acknowledgments

The data collection for this research was supported by the Health Economics and HIV and AIDS Research Division (HEARD).

Disclosure statement

No potential conflict of interest was reported by the authors.