Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana.
BACKGROUND
Botswana has the highest rate of HIV infection in the world, estimated at 36% among the population aged 15-49 years. To improve antiretroviral (ARV) treatment delivery, we conducted a cross-sectional study of the social, cultural, and structural determinants of treatment adherence.


METHODS
We used both qualitative and quantitative research methodologies, including questionnaires and interviews with patients receiving ARV treatment and their health care providers to elicit principal barriers to adherence. Patient report and provider estimate of adherence (>/=95% doses) were the primary outcomes.


RESULTS
One hundred nine patients and 60 health care providers were interviewed between January and July 2000; 54% of patients were adherent by self-report, while 56% were adherent by provider assessment. Observed agreement between patients and providers was 68%. Principal barriers to adherence included financial constraints (44%), stigma (15%), travel/migration (10%), and side effects (9%). On the basis of logistic regression, if cost were removed as a barrier, adherence is predicted to increase from 54% to 74%.


CONCLUSIONS
ARV adherence rates in this study were comparable with those seen in developed countries. As elsewhere, health care providers in Botswana were often unable to identify which patients adhere to their ARV regimens. The cost of ARV therapy was the most significant barrier to adherence.
Weiser
Sheri
S
Department of Medicine, UCSF, San Francisco General Hospital Medical Center, 1001 Potrero Avenue, 1M3, San Francisco, CA, 94110, USA. sweiser@itsa.ucsf.edu
Wolfe
William
W
Bangsberg
David
D
Thior
Ibou
I
Gilbert
Peter
P
Makhema
Joseph
J
Kebaabetswe
Poloko
P
Dickenson
Dianne
D
Mompati
Kgosidialwa
K
Essex
Max
M
Marlink
Richard
R
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001902:Botswana; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D004522:Educational Status; D005260:Female; D015497:HIV-1; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D009790:Occupations; D010349:Patient Compliance; D011795:Surveys and Questionnaires
D019380:Anti-HIV Agents