title: Barriers to acceptance and adherence of antiretroviral therapy in urban Zambian women: a qualitative study.
abstract: Sub-Saharan Africa contains over 60% of the world's HIV infections and Zambia is among the most severely affected countries in the region. As antiretroviral programs have been rapidly expanding, the long-term success of these programs depends on a good understanding of the behavioral determinants of acceptance and adherence to antiretroviral therapy (ART). The study used qualitative methods to gain local insight into potentially important factors affecting HIV-infected women's decision to accept or continue with ART. Some of the barriers identified by this study are consistent with factors cited in the existing adherence literature from both developed and developing nations such as side effects, hunger and stigma; other factors have not been previously reported. One major theme was unfamiliarity with the implications of having a chronic, potentially deadly disease. Other emerging themes from this study include the complicated effect of ART on interpersonal relationship, particularly between husbands and wives, the presence of depression and hopelessness, and lack of accurate information. The results suggest that the reasons for non-uptake of treatment include issues related to local cultural frameworks (e.g., illness ideology), mental and behavioral health (e.g., depression and/or interpersonal challenges), stigma, and motivating factors (e.g., values of church or marriage) of different cultures that affect the ability and willingness to take life-saving medicine for a long period of time. Qualitative studies are critical to better understand why ART eligible individuals are choosing not to initiate or continue treatment to achieve needed adherence levels.
authors.affiliation: Boston University School of Public Health, Center for International Health and Development, Boston, MA, USA. lkmurray@bu.edu
authors.forename: Laura K
authors.initials: LK
authors.lastname: Murray
authors.forename: Katherine
authors.initials: K
authors.lastname: Semrau
authors.forename: Ellen
authors.initials: E
authors.lastname: McCurley
authors.forename: Donald M
authors.initials: DM
authors.lastname: Thea
authors.forename: Nancy
authors.initials: N
authors.lastname: Scott
authors.forename: Mwiya
authors.initials: M
authors.lastname: Mwiya
authors.forename: Chipepo
authors.initials: C
authors.lastname: Kankasa
authors.forename: Judith
authors.initials: J
authors.lastname: Bass
authors.forename: Paul
authors.initials: P
authors.lastname: Bolton
mesh_terms: D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005239:Fear / Q000523:psychology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D055118:Medication Adherence / Q000523:psychology*; D036301:Qualitative Research; D011795:Surveys and Questionnaires; D014505:Urban Population; D015024:Zambia
chemical_list: D044966:Anti-Retroviral Agents