Factors facilitating and challenging access and adherence to antiretroviral therapy in a township in the Zambian Copperbelt: a qualitative study

Abstract

Antiretroviral therapy is increasingly available in African communities. We set out to gain patient perceptions on factors that facilitate and challenge access and adherence to such therapy. We carried out two semi-structured interviews 12 months apart with 40 HIV-positive people drawn from three economically deprived townships in the Copperbelt, Zambia. We also conducted a focus group of 12 of these interviewees. Availability of medication in health facilities did not automatically ensure access to those in need. A prerequisite for commencing on treatment was a positive documented HIV test result, but too few HIV testing centres, fear of family and community rejection and male domination in sexual and social decision-making prevented a number from coming forward to be tested. Once within the system of care, further barriers, such as rumours of bad side-effects, inconsistent information, high costs of drugs (at the time of the first interviews), ongoing costs of additional medical tests, overcrowded systems and overworked staff, all hindered access to receiving treatment. When taken, therapy brought side-effects, the most common being increased appetite and hunger. Yet, despite these barriers and challenges many of those on treatment reported good adherence. Immediate factors, such as seeing ill people becoming well; being supported by a friend or family member; and having a watch or clock to keep to a regular regime, were important. The increase in the number of people who were expected to die but were now looking well also shifted community attitudes. HIV/AIDS is beginning to move from a hidden terminal disease to a chronic condition that is treatable.

Keywords:

• adherence
• AIDS
• antiretroviral therapy
• HIV
• Zambia

Acknowledgements

The Winston Churchill Travelling fellowship and the Perry Fund funded this study. We are grateful for the support of the Isubilo Community Resource Programme, Dr Andy Patching, Dr Jabbin Mulwanda and the study participants. We thank Nic Robertson for developing the participant grid, Morag Edwards for secretarial support and Gordon Scott, Aziz Sheikh, Barbara McPake and Janet Sikasote for their pertinent comments on this paper.