The charms and challenges of antiretroviral therapy in Uganda: the DART experience

Abstract

Antiretroviral therapy (ART) improves the quality of life of people living with HIV/AIDS. However, adherence remains a challenge. A total of eight focus group discussions (FGD) were conducted with participants from a randomised controlled trial that monitored strategies for managing ART in African adults: Development of Antiretroviral Therapy. All FGD participants had received ART for at least one year. Perceived benefits of ART were key motivators for adherence. These benefits included improved physical health, restored self-esteem, acceptance in the community and hope for a longer and healthier life and reduced fear of HIV/AIDS-related death. Barriers to adherence included a high pill burden, ART side effects and socio-economic constraints, including lack of food and safe water for taking the pills. Visible ART side effects and involvement in an exclusively HIV/AIDS clinic could expose their HIV status, thus exacerbating stigma. Gender and socio-economic differences were found in the variety of strategies employed to ensure adherence. ART was perceived as improving the overall quality of life of recipients; however, it is crucial for ART programmes to be gender and socio-economic cognizant in order to enhance adherence to a lifelong therapy.

Keywords:

• adherence
• antiretroviral treatment
• focus group discussions
• gender
• HIV/AIDS
• side effects
• Uganda

Acknowledgements

The authors would like to express their gratitude to the study participants from the DART Trial who gave in their time and contributed to the discussions that provided the findings presented in this article. We acknowledge Prof Grosskurth Heiner who contributed to the writing of the manuscript. This research was funded by ABBA RPC-Addressing the Burden of Balance in AIDS Research Programme Consortium, Liverpool School of Tropical Medicine