Personal barriers to antiretroviral therapy adherence: case studies from a rural Uganda prospective clinical cohort.
BACKGROUND
Although good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes, some patients may have specific personal barriers to ART adherence.


OBJECTIVE
To study specific personal barriers to ART adherence.


METHODS
Quantitative data on patients' health status, ART adherence, CD4 cell counts and viral loads were collected, and qualitative data on life experiences of five patients with poor ART outcomes and adherence were also collected.


RESULTS
Out of 35 patients with poor immunological and virological ART outcomes, 17 (49%) also had poor ART adherence. Patient 1 had no living child and did not disclose her HIV serostatus to her spouse because she wanted to have a child. Patient 2 was an orphan with neither social nor family support. Patient 3 stopped ART when she conceived, returned to the study clinic when pregnant again and was sickly. She was switched to second-line ART with satisfactory outcomes. Patient 4, a 14 year old orphan had missed ART for 2 months when his treatment supporter was away. Patient 5 aged 66 years stopped ART which he blamed for his erectile dysfunction.


CONCLUSIONS
ART adherence counselling should target specific personal barriers to ART adherence like: lack of family support, health and sexual life concerns, desire to have children and family instability.
MRC/UVRI -Uganda Research Unit on AIDS. P.O. Box 49, Entebbe, Uganda.
B N
BN
Mayanja
E
E
Kabunga
B
B
Masiira
R
R
Lubega
P
P
Kaleebu
J
J
Seeley
D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D011247:Pregnancy; D011446:Prospective Studies; D012424:Rural Population; D014454:Uganda / Q000453:epidemiology; D019562:Viral Load; D055815:Young Adult
D044966:Anti-Retroviral Agents
ART adherence; Personal barriers; children desire; disclosure; sexual dysfunction; stigma