An assessment of the challenges of the HIV positive people on antiretroviral therapy adherence

Abstract

ART is increasingly available in the world including African communities (Grant, et al. 2008) and its availability has dramatically increased survival rates and substantially modified the course of HIV infection, which has now become a chronic disease both in adults and in children (Vigano, et al. 2011). However it is not clear whether all HIV positive people on ART access ART alike. Therefore there was need to assess the challenges of the HIV positive people on ART adherence. Major objective was to assess the challenges of the HIV positive people on ART adherence. Research questions were: What are the categories of people who access ART, What are the challenges that may limit adherence to the instructions of taking ART, What are the coping mechanisms of the HIV positive people on ART? Case study was Mildmay Uganda, an organization supporting HIV positive people. Qualitative methods and interview guides were used in data collection where a total of 30 participants were interviewed. There were four focus group discussions with eight members each. 10 key informant interviews for health care service providers were conducted. Findings were: categories of people that access ART at Mildmay Uganda are people with low CD4 cell counts (n=28) and those in advanced stages (3 and 4) of HIV progression (n=7). Medical challenges which included side effects such as vomiting (n=8), pill burden (n=18). Social challenges included: stigma and discrimination (n=22). Economic challenges included: poverty (n=23), loss of jobs (n=2). These findings were supported by key informants during key informant interviews. The copying mechanisms of people on ART included; ongoing support counseling (n=27), among others. Conclusion was that people with low CD4cell count access ART, side effects, stigma, discrimination, lack of family and community support are huge obstacles that limited adherence to instructions of taking ARVs. Recommendations to government and other stakeholders are to, intensify health education campaigns against stigma and promote family and community support for HIV positive people, develop adequate and appropriate pediatric antiretroviral therapy formulations, and develop simpler ARVs to take with few pills and few side effects, among others