Barriers and facilitators of adherence to antiretroviral drug therapy and retention in care among adult HIV-positive patients: a qualitative study from Ethiopia.
BACKGROUND
Antiretroviral therapy (ART) has been life saving for hundreds of thousands of Ethiopians. With increased availability of ART in recent years, achievement of optimal adherence and patient retention are becoming the greatest challenges in the management of HIV/AIDS in Ethiopia. However, few studies have explored factors influencing medication adherence to ART and retention in follow-up care among adult Ethiopian HIV-positive patients, especially in the Amhara region of the country, where almost one-third of the country's ART is prescribed. The aim of this qualitative study was to collect such data from patients and healthcare providers in the Amhara region of Ethiopia.


METHODS
Semi-structured interviews were conducted with 24 patients, of whom 11 had been lost to follow-up and were non-persistent with ART. In addition, focus group discussions were performed with 15 ART nurses and 19 case managers. All interviews and focus groups were audio-recorded, transcribed, and coded for themes and patterns in Amharic using a grounded theory approach. The emergent concepts and categories were translated into English.


RESULTS
Economic constraints, perceived stigma and discrimination, fasting, holy water, medication side effects, and dissatisfaction with healthcare services were major reasons for patients being non-adherent and lost to follow-up. Disclosure of HIV status, social support, use of reminder aids, responsibility for raising children, improved health on ART, and receiving education and counseling emerged as facilitators of adherence to ART.


CONCLUSIONS
Improving adherence and retention requires integration of enhanced treatment access with improved job and food security. Healthcare providers need to be supported to better equip patients to cope with the issues associated with ART. Development of social policies and cooperation between various agencies are required to facilitate optimal adherence to ART, patient retention, and improved patient outcomes.
Division of Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia; College of Medicine and Health Science, Bahir-Dar University, Gojjam, Ethiopia.
Woldesellassie M
WM
Bezabhe
Division of Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia.
Leanne
L
Chalmers
Division of Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia.
Luke R
LR
Bereznicki
Division of Pharmacy, School of Medicine, University of Tasmania, Tasmania, Australia.
Gregory M
GM
Peterson
Department of Internal Medicine, Felege-Hiwot Hospital, Gojjam, Ethiopia.
Mekides A
MA
Bimirew
Department of Internal Medicine, Gondar University Hospital, Gondar, Ethiopia.
Desalew M
DM
Kassie
D000163:Acquired Immunodeficiency Syndrome / Q000188:drug therapy*; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods; D003376:Counseling / Q000379:methods; D005002:Ethiopia; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D059012:Lost to Follow-Up; D008297:Male; D055118:Medication Adherence; D036301:Qualitative Research; D012944:Social Support; D012959:Socioeconomic Factors
D019380:Anti-HIV Agents; D044966:Anti-Retroviral Agents