Exploration of factors that influence poor adherence to antiretroviral therapy amongst patients at Pule Sefatsa primary health care clinic in Mangaung district, South Africa.

Abstract

Background: Over the past decade, South Africa has scaled-up its antiretroviral treatment (ART) programme in an effort to control the HIV epidemic. Interventions to support the rollout of ART include task shifting ART initiation to nurses at primary health care level and ensuring HIV adherence counselling at every visit by lay counsellors. Furthermore, community-based outreach teams work at the community level to follow up on patients and ensure that patients remain in care and are adhering to ART. Despite all these efforts, poor adherence to ART remains a pertinent problem. In 2016, the national adherence to ART rate among adult patients was estimated at 35% compared to 39% in Pule Sefatsa clinic in Mangaung district, Free-state Province. Aim: The aim of the study was to explore the factors that influence poor adherence to ART among patients receiving ART at Pule Sefatsa primary health care clinic in Mangaung district, South Africa. Methodology: A descriptive qualitative research approach was used. Two focus group discussions were conducted with health workers and community caregivers and 16 in-depth interviews were conducted with ART patients who are in care and those who had defaulted on their treatment. Audio recorded data obtained from these sources were transcribed verbatim and prepared for analysis. Thematic analysis was used for data analysis and the results were classified under various categories. Findings: Adherence to ART in Pule Sefatsa clinic was found to be influenced by medical related factors, socio-economic factors, health system factors and individual factors. The medical-related factor was the side effects of the medication. The socio-economic factors were stigma and discrimination, lack of family support, poverty and food insecurity. Health system factors that hindered adherence to ART were medication stock-outs, long waiting times and poor service delivery. The final group of barriers to ART adherence was related to the individuals using ART and these include patients forgetting to take treatment and feeling depressed.