The perspectives of users of antiretroviral therapy on structural barriers to adherence in South Africa

  • Ashraf Kagee University of Stellenbosch
  • Jani Nothling University of Stellenbosch
  • Bronwyne Coetzee University of Stellenbosch
Keywords: Adherence, Antiretroviral therapy, Structural barriers

Abstract

Background: The effectiveness of antiretroviral therapy (ART) and the importance of adherence to treatment regimens are widely known. Yet, suboptimal adherence to ART and retention in care of patients still persists and, by many accounts, is fairly widespread. The aim of this study was to identify the structural barriers that influenced adherence among patients who were enrolled in the national ART programme in South Africa. Method: In this qualitative study, semi-structured interviews were conducted with a sample of 10 patients receiving ART at a public hospital in South Africa. Results: The results of the interviews were categorised according to poverty-related, institution-related and social barriers to clinic attendance and pill-taking, which collectively formed the structural barriers to adherence. The chief structural barriers to clinic attendance were time away from work, transport expenses, long waiting times and negative experiences with clinic staff. The chief barriers to pill-taking were food insecurity, stigma and discrimination. Conclusion: The barriers to adherence are discussed. Attention is called to the extraindividual factors that influenced ART adherence. We conclude that contextual factors, such as a healthcare-enabling environment, might play an important role in influencing healthcare-promoting behaviour among patients.

Author Biographies

Ashraf Kagee, University of Stellenbosch
PhD, MPH Professor of Psychology Department of Psychology Stellenbosch University
Jani Nothling, University of Stellenbosch
MA Master’s Graduate Department of Psychology Stellenbosch University
Bronwyne Coetzee, University of Stellenbosch
MSc Doctoral Student Department of Psychology Stellenbosch University
Published
2012-07-30
Section
Original Research