Identifying structural barriers to antiretroviral therapy adherence

[摘要] ENGLISH ABSTRACT: The topic of antiretroviral adherence remains a subject of continued importance, as it isassociated with positive health outcomes amongst patients attending public healthcarefacilities. Available literature on adherence behaviour mainly focuses on the psychologicaland behavioural barriers, while overlooking the multitude of structural barriers within thepatient's environment affecting the patient's adherence to antiretroviral treatment and care.The present study provides a unique perspective on adherence behaviour amongst personsliving with HIV and receiving antiretroviral treatment, as it identifies important structuralbarriers to clinical attendance and pill-taking.The sample for this study were selected from patients attending an infectious diseasesclinic at a major peri-urban secondary hospital and receiving antiretroviral therapy, nursesand doctors providing health services to patients, and patient advocates providingpsychosocial support to patients under the auspices of a local non-governmental organisation.The participants included in this study were selected by means of convenience sampling toparticipate either in semi structured interviews or focus group discussions. Participants wereassured of the confidentiality of the process and their anonymity in both cases. Both semistructured interviews and focus groups were digitally recorded and transcribed after whichtranscriptions were entered into Atlas.ti for textual analysis. Transcriptions were thematicallyanalysed according to the perceptions of various participants. The main themes that emergedfrom the present study included individual barriers, poverty-related barriers, institutionrelatedbarriers, and social and community-related barriers.The results of the present study were triangulated by considering the concurrences anddiscrepancies between the patients, clinicians and patient advocates on the main, andsubthemes. These themes were then discussed according to Bronfenbrenner's (1972)Ecological Systems Theory, which divided the main themes identified according to the different systems operating within the patient's environment, i.e. the micro-, exo-, andmacrosystem. The microsystem included both individual psychological and behaviouralbarriers and poverty-related barriers. Institutional barriers were considered within the exosystemof the patient's ecological environment. And the social and community-relatedbarriers were considered within the macrosystem of the patient's ecological environment.The significance of this study lies in the identification of adherence behaviour as theproduct of the patient's environment through the examination of triangulated data. Futureresearch may include effective ways in which patients can be assisted in developing thenecessary skills to cope with their environment and to enhance social support. Thedevelopment of strategies to support newly-enrolled patients also still needs investigation.

[发布机构] Stellenbosch University