Perspectives on ART adherence among Zambian adults living with HIV: insights raised using HIV-related disability frameworks

ABSTRACT

Anti-retroviral treatment (ART) has improved the survival of people living with HIV in Africa. Living with chronic HIV comes with new health and functional challenges and the need to manage ART adherence. The Sepo Study applied disability frameworks to better understand living with chronic HIV while using ART. The study followed 35 people (18 women, 17 men) living with HIV and on ART 6 months or longer in private and public health facilities in Lusaka, Zambia over 18-months (2012–2015). A total of 99 in-depth interviews were conducted. Conventional content analysis and NVIVOv10 were applied to analyse the data. Participants were adhering to ART at the times of the interviews and therefore less likely to report major challenges with adherence. Three main themes emerged from the data related to adherence. Firstly, ART was regarded as “giving life”, which underscored adherence. Secondly, all participants described strategies for to managehealth and functional limitations, which they attributed as side-effects or chronicity. Thirdly, participants described experiences of uncertainty, including the efficacy of new regimens, potential loss of functioning, risk of new health problems, and death. Long-term ART managment in Africa needs to integrate rehabilitation approaches to address functional limitations, uncertainties, strengthen and support for adherence.

KEYWORDS:

• HIV
• disability
• functioning
• Africa
• Zambia
• adherence
• ART

Acknowledgements

We thank the women and men who courageously shared their personal stories with us so that we can better understand the experiences of living with HIV on ART in Lusaka, Zambia. We also acknowledge our generous collaborators at the two health facilities that participated as study sites. JHH wrote the first and final draft of the paper and was part of the team conceptualising the study and developing the research tools. CC, GB, MM, AM and PS have been part of conceptualising the study and/or implementing the study in Zambia. They have also written parts of the paper and reviewed the first and final draft. SN is the PI of the study and has been part of all elements of the study. She has reviewed the first and final draft of this paper.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Jill Hanass-Hancock http://orcid.org/0000-0003-3662-8548

Additional information

Funding

This work was supported by the Canadian Institutes of Health Research under [grant number 114907].