title: "That is why I stopped the ART": patients' & providers' perspectives on barriers to and enablers of HIV treatment adherence in a South African workplace programme.
abstract: BACKGROUND
  As ART programmes in African settings expand beyond the pilot stages, adherence to treatment may become an increasing challenge. This qualitative study examines potential barriers to, and facilitators of, adherence to ART in a workplace programme in South Africa.
  
  
  METHODS
  We conducted key informant interviews with 12 participants: six ART patients, five health service providers (HSPs) and one human resources manager.
  
  
  RESULTS
  The main reported barriers were denial of existence of HIV or of one's own positive status, use of traditional medicines, speaking a different language from the HSP, alcohol use, being away from home, perceived severity of side-effects, feeling better on treatment and long waiting times at the clinic. The key facilitators were social support, belief in the value of treatment, belief in the importance of one's own life to the survival of one's family, and the ability to fit ART into daily life schedules.
  
  
  CONCLUSIONS
  Given the reported uncertainty about the existence of HIV disease and the use of traditional medicines while on ART, despite a programme emphasising ART counselling, there is a need to find effective ways to support adherence to ART even if the individual does not accept biomedical concepts of HIV disease or decides to use traditional medicines. Additionally, providers should identify ways to minimize barriers in communication with patients with whom they have no common language. Finally, dissatisfaction with clinical services, due to long waiting times, should be addressed.
authors.affiliation: Clinical Research Unit, Department of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London, UK. mison.dahab@lshtm.ac.uk
authors.forename: Mison
authors.initials: M
authors.lastname: Dahab
authors.forename: Salome
authors.initials: S
authors.lastname: Charalambous
authors.forename: Robin
authors.initials: R
authors.lastname: Hamilton
authors.forename: Katherine
authors.initials: K
authors.lastname: Fielding
authors.forename: Karina
authors.initials: K
authors.lastname: Kielmann
authors.forename: Gavin J
authors.initials: GJ
authors.lastname: Churchyard
authors.forename: Alison D
authors.initials: AD
authors.lastname: Grant
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D001291:Attitude of Health Personnel; D001294:Attitude to Health; D015658:HIV Infections / Q000188:drug therapy*; D006801:Humans; D007407:Interviews as Topic; D009786:Occupational Health Services; D010349:Patient Compliance; D011369:Professional-Patient Relations; D015397:Program Evaluation; D013019:South Africa
chemical_list: D044966:Anti-Retroviral Agents