Barriers and facilitators to Antiretroviral therapy adherence among adult HIV positive patients in Hawassa, Southern Ethiopia: a qualitative grounded theory study

Authors

  • Habtamu Wondiye Department of Clinical Nursing, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
  • Netsanet Fentahun Department of Health Education and Behavioral science, Jimma University, Ethiopia
  • Rupali J. Limaye Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Maryland, USA
  • Mesfin Kote Department of Epidemiology and Biostatistics, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
  • Eshetu Girma School of Public Health, Addis Ababa University

Abstract

Background: Antiretroviral therapy (ART) not only prevents AIDS-related illness and death: it also has the potential to significantly reduce the risk of HIV transmission and the spread of tuberculosis. Patient’s adherence is crucial to get the best out of ART. As ART is scaled up in Ethiopia, there is a need for better understanding of the factors that influence patients’ adherence to ART which is used to develop culturally appropriate and effective interventions which are in turn more likely lead to successful and sustainable programs for patients with HIV/AIDS. This study aims to explore patients’ and health care professionals’ views about factors that facilitate and constrain optimal adherence to ART among adult HIV patients. Methods: At two health facilities that serve a large number of HIV-positive individuals in Hawassa town, Southern Ethiopia, a qualitative study using non-participant observation; and in-depth interview with 23 ARV user and 5 health professionals were carried out from February to April 2014. Simultaneous data collection and analysis was used and taped data and note were transcribed into Amharic then translated into English. The grounded theory approach was used for analyzing the data as a whole. The analysis began by using the constant comparison approach. The coding process was preceded by open coding, axial and selective coding. All of the codes used were inductive. To manage the overall coding process, Atlas.ti (v.7) software was used. To assure the quality of the research findings different set of criteria were used focusing on the credibility, dependability, transferability and confirmability of the study. Result: The most frequently emerged barriers to adherence included economic constraints, substance misuse, simply forgetting and being busy, fear of stigma and discrimination, pill burden and medication side effects. The most frequently emerged facilitators to adherence included disclosure of HIV status, using an adherence aid, prospects of living longer, social support, experiencing better health and trusting health workers. Conclusion: Overall, these findings were similar to the barriers and facilitators experienced by individuals on ART in other resource constrained setting. Policy-makers and concerned bodies should identify and develop appropriate social policy to promote adherence among ART-prescribed patients whilst Health professionals should aware and address some of the pragmatic and cultural issues around ART. Keywords: Grounded theory, ART, HIV/AIDS, qualitative research

Author Biographies

Habtamu Wondiye, Department of Clinical Nursing, Arba Minch College of Health Sciences, Arba Minch, Ethiopia

MPH

Netsanet Fentahun, Department of Health Education and Behavioral science, Jimma University, Ethiopia

MPH

Rupali J. Limaye, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Maryland, USA

PhD

References

Ethiopian Federal Ministry of Health HIV/AIDS Prevention and Control Office. Country progress report in HIV/AIDS response. Addis Ababa: Ethiopian Federal Ministry of Health HIV/AIDS Prevention and Control Office, 2012.

Ministry of Health of Ethiopia: Guideline for Implementation of Antiretroviral Therapy in Addis Ababa, Ethiopia 2007.

UNAIDS (2013). Global Report on the HIV Epidemic (Geneva: UNAIDS).

UNAIDS (2012). Global Report on the HIV Epidemic (Geneva: UNAIDS).

WHO, UNAIDS and UNICEF (2013). Global Update on HIV Treatment 2013: Results, Impact and Opportunities (Geneva: WHO, UNAIDS and UNICEF). 2013:15.

World Health Organization: Adherence to Long Term Therapies: Evidence for Action. Geneva: World Health Organization 2003 [http://whqlibdoc.who.int/publications/2003/9241545992.pdf].

Low-Beer, S., Yip, B., O’Shaughnessy, M.V., Hogg, R.S., & Montana, J.S. (2000).Adherence to triple therapy and viral load response. Journal of Acquired Immune Defeciency Syndrome, 23(4), 360-361.

Shuter, J., Sarlo, J., Kanmaz, T., Rhode, R., & Zingman, B. (2007). HIV-infected clients receiving Lopinavir/Ritonavir-based antiretroviral therapy achieve high rates of virologic suppression despite adherence rates less than 95%. Journal of Acquired Immune Deficiency Syndrome, 45(1), 4-8.

Avert. (2008b). Introduction to HIV/AIDS Treatment. Retrieved March 11, 2008, from {Error! Hyperlink reference not valid.

Bangsberg, D.R., Perry, S., Charlebois, E.D., Clark, R.A., Roberston, M., Zolopa, A.R.,& Moss, A. (2001). Non-adherence to highly active antiretroviral therapy predicts progression to AIDS. AIDS, 15(9), 1181-1183.

Hogg, R., Yipp, B., Chan, K. O’Shaughnessy, M., & Montaner, J. (2000). Non-adherence to triple combination ART is predictive of AIDS progression and death in HIV positive men and women. Paper presented at the XIIIth International AIDS conference, Durban.

World Health Organization Country Office Ethiopia, annual report,2011.

Beyene KA, Gedif T, Gebre-Mariam T, et al. Highly active antiretroviral therapy adherence and its determinants in selected hospitals from south and central Ethiopia. Pharmacoepidemiol Drug Saf 2009;18:1007–15.

Carr A, Cooper DA. Adverse effects of antiretroviral therapy. Lancet 2000;356:1423–30.

Vervoort SCJM, Borleffs JCC, Hoepelman AIM, Crypdonck MHF. Adherence in antiretroviral therapy:A review of qualitative studies. AIDS 2007;21:271–281. [PubMed: 17255734].

Glaser BG, Strauss AL.(1967).The discovery of grounded theory:strategies for qualitative research. New York, New York: Aldine Publishing Company.

Corbin J, Strauss A: Basics of qualitative research: Techniques and proceduresfor developing grounded theory 3rd ed. Thousand Oaks, California: Sage Publications; 2008.

Guba, E., Lincoln, Y. (1989) Fourth Generation Evaluation. California: SAGE Publications.

Burns N. & Grove S. K. Understanding Nursing Research Building an Evidence-Based Practice 5th ed. U.S.A: Elsevier Saunders; 2011.

Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, Wu P, Wilson K, Buchan I, Gill CJ, Cooper C: Adherence to HAART: a systematic review of developed and developing nation client-reported barriers and facilitators. PLoS medicine 2006, 3(11):e438.

Balcha TT, Jeppsson A, Bekele A (2011) Barriers to antiretroviral treatment in Ethiopia: a qualitative study. J Int Assoc Physicians AIDS Care (Chic) 10: 119–125.

Gusdal AK, Obua C, Andualem T, Wahlstrom R, Tomson G, et al. (2009) Voices on adherence to ART in Ethiopia and Uganda: a matter of choice or simply not an option? AIDS Care 21: 1381–1387.

Lifson AR, Demissie W, Tadesse A, Ketema K, May R, et al. (2013) Barriers to retention in care as perceived by persons living with HIV in rural Ethiopia: focus group results and recommended strategies. J Int Assoc Provid AIDS Care 12:32–38.

Wasti SP, Simkhada P, Randall J, Freeman JV, van Teijlingen E (2012) Factors influencing adherence to antiretroviral treatment in Nepal: a mixed-methods study. PLoS One 7: e35547.

Wasti SP, van Teijlingen E, Simkhada P, Randall J, Baxter S, et al. (2012) Factors influencing adherence to antiretroviral treatment in Asian developing countries: a systematic review. Trop Med Int Health 17: 71–81.

Merten S, Kenter E, McKenzie O, Musheke M, Ntalasha H, et al. (2010) Client-reported barriers and drivers of adherence to antiretrovirals in subSaharan Africa: a meta-ethnography. Trop Med Int Health 15 Suppl 1: 16–33.

Murphy DA, Roberts KJ, Hoffman D, Molina A, Lu MC. Barriers and successful strategies to antiretroviral adherence among HIV-infected monolingual Spanish-speaking clients. AIDSCare2003;15:217-30.

Hendershot CS, Stoner SA, Pantalone DW, Simoni JM. Alcohol use and antiretroviral adherence:review and meta-analysis. J Acquir Immune Defic Syndr 2009;52:180-202.

Lucas GM, Gebo KA, Chaisson RE, Moore RD.Longitudinal assessment of the effects of drug and alcohol abuse on HIV-1 treatment outcomes in an urban clinic. AIDS 2002;16:767-74.

Tuller DM, Bangsberg DR, Senkungu J, Ware NC, Emenyonu N, Weiser SD. 2010. Transportation costs impede sustained adherence and access to HAART in a clinic population in southwestern Uganda: A qualitative study. AIDS and Behavior 14: 778–784. .

Badahdah AM, Pedersen DE. 2011. I want to stand on my own legs: A qualitative study of antiretroviral therapy adherence among HIV-positive women in Egypt. AIDS Care 23: 700–704.

Sanjobo N, Frich JC, Fretheim A. 2008. Barriers and facilitators to clients’ adherence to antiretroviral treatment in Zambia: A qualitative study. AHARA-J: Journal of Social Aspects of HIV/AIDS 5: 136–143.

Kagee A, Delport T. 2010. Barriers to adherence to antiretroviral treatment: the perspectives of client advocates. Journal of Health Psychology 15: 1001–1011. .

Weiser SD, Palar K, Frongillo EA, Tsai AC, Kumbakumba E, et al. (2013)Longitudinal assessment of associations between food insecurity, antiretroviral adherence and HIV treatment outcomes in rural Uganda. AIDS.

Hardon, A.P, Akurut, D., Comoro, C., Ekezie, C., Irunde, H.F., Gerrits, T., Kglatwane, J., Kinsman, J., Kwasa, R., Maridadi, J., Moroka, T.M., Moyo,S., Nakiyemba, A., Nsimba, S., Ogenyi, R., Oyabba, T., Temu, F. & Laing,R. (2007). Hunger, waiting time, and transport costs: Time to confront challenges to ART adherence in Africa. AIDS Care, 19, 658-665.

Nachega, J.B., Knowlton, A.R., Deluca, A., Schoeman, J.H., Waltkinson, L.,Efron, A., Chaisson, R.E. & Maartens, G. (2006). Treatment supporter to improve adherence to antiretroviral therapy in HIV-infected South African adults: A qualitative study. Journal of Acquired Immune Deficiency Syndromes, 43 Suppl 1, S127-133.

Rao D, Kekwaletswe TC, Hosek S, Martinez J, Rodriguez F. Stigma and social barriers to medication adherence with urban youth Living with HIV.AIDS Care 2007;19:28-33.

Adeneye AK, Adewole TA, Musa AZ, Onwujekwe D, Odunukwe NN, Araoyinbo ID et al. Limitations to access and use of antiretroviral therapy (ART) among HIV positive persons in Lagos, Nigeria. World Health Popul 2006;8:46-56.

Brown L, Macintyre K, Trujillo L. 2003. Interventions to reduce HIV/AIDS stigma: What have we learned? AIDS Education and Prevention 15: 49–69.

Babalola S, Fatusi A, Anyanti J. 2009. Media saturation,communication exposure and HIV stigma in Nigeria. Social Science & Medicine 68: 1513–1520.

Wubshet M, Berhane Y, Worku A, Kebede Y (2013) Death and seeking alternative therapy largely accounted for lost to follow-up of clients on ART in Northwest Ethiopia: a community tracking survey. PLoS One 8: e59197.

Weiser S, Wolfe W, Bangsberg D, Thior I, Gilbert P, Makhema J,Kebaabetswe P, Dickenson D, Mompati K, Essex M, Marlink R. 2003. Barriers to antiretroviral adherence for clients living with HIV infection and AIDS in Botswana. Journal of Acquired Immune Deficiency Syndromes 34: 281–288.

Laniece I, Ciss M, Desclaux A, Diop K, Mbodj F, Ndiaye B, Sylla O, Delaporte E, Ndoye I. 2003. Adherence to HAART and its principal determinants in a cohort of Senegalese adults. AIDS 17: S103–S108.

Ammassari, A., Murri, R., Pezzotti, P., Trotta, M.P., Ravasio, L., De Longis, P., et al. (2001). Self-reported symptoms and medication side effects influence adherence to highly active antiretroviral therapy in persons with HIV Infection. Journal of Acquired Immune Deficiency Syndromes, 28(5), 445-449.

Murphy, R.L. (2003). Defining the toxicity profile of nevirapine and other antiretroviral drugs. Journal of Acquired Immune Deficiency Syndromes,34 (Supp 1), S15-S20.

Altice, F L. ; Mostashari, F., & Friedland, G. H. (2001). Trust and the acceptance of and adherence to antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes,28(1), 47-58.

Puccio JA, Belzer M, Olson J, Martinez M, Salata C, Tucker D, Tanaka D: The use of cell phone reminder calls for assisting HIV-infected adolescents and young adults to adhere to highly active antiretroviral therapy: a pilot study. AIDS Client Care STDS 2006, 20(6):438-444.

Chang LW, Kagaayi J, Nakigozi G, Packer AH, Serwadda D, Quinn TC,Gray RH, Bollinger RC, Reynolds SJ: Responding to the human resource crisis: peer health workers, mobile phones, and HIV care in Rakai,Uganda. AIDS Client Care STDS 2008, 22(3):173-174.

Pop-Eleches C, Thirumurthy H, Habyarimana JP, Zivin JG, Goldstein MP,et al. (2011) Mobile phone technologies improve adherence to antiretroviral treatment in a resource-limited setting: a randomized controlled trial of text message reminders. AIDS 25: 825–834.

Lester RT, Ritvo P, Mills EJ, Kariri A, Karanja S, et al. (2010) Effects of a mobile phone short message service on antiretroviral treatment adherence in Kenya (WelTel Kenya1): a randomised trial. Lancet 376: 1838–1845.

Fynn R, Jager Dd, Chan H, Anand S, Rivett U: Remote HIV/AIDS client monitoring tool using 3G/GPRS packet-switched mobile technology. In: Institution of Engineering and Technology. 4th Institution of Engineering and Technology Seminar on Appropriate Healthcare Technologies forDeveloping Countries. London 2006.

Mills EJ, Nachega JB, Buchan I, Orbinski J, Attaran A, Singh S, Rachlis B, Wu P, Cooper C. 2006a. Adherence to HAART: A systematic review of developed and developing nation client-reported barriers and facilitators. PLoS Medicine 3: e438.

Published

2020-12-29

How to Cite

Wondiye, H., Fentahun, N., Limaye, R. J., Kote, M., & Girma, E. (2020). Barriers and facilitators to Antiretroviral therapy adherence among adult HIV positive patients in Hawassa, Southern Ethiopia: a qualitative grounded theory study. The Ethiopian Journal of Health Development, 28(1). Retrieved from https://ejhd.org/index.php/ejhd/article/view/70

Most read articles by the same author(s)

1 2 > >>