Socio-demographic factors affecting adherence to antiretroviral therapy in a wellness centre in South Africa

Abstract

Patients' non-adherence to antiretroviral treatment remains a public health challenge in most developing countries, including South Africa. Although the Government avails all efforts to ensure ART availability in hospitals around the country, non-adherence to ART is still a major concern. Accordingly, quantitative and qualitative data were collected from patients enrolled into treatment between 2010 and 2014. These mixed methods were applied at a wellness centre in the Mpumalanga province of South Africa to examine the effect of selected social and demographic factors on patients' antiretroviral therapy treatment. The sample size of the quantitative approach was 777 patients enrolled on ART, of which 486 patients made up the group of patients who have not defaulted, while 291 patients made up the group of defaulting patients. On the other hand, the qualitative survey covered 20 patients, including 10 defaulters and 10 non-defaulters, to ascertain the psychosocial factors influencing ART uptake at the Piet Retief Wellness Centre. The quantitative approach, therefore, indicated that the patients started defaulting from the first month of initiating treatment and all patients ended defaulting by the 55 months. In terms of the socio-demographic predictors, while there was no statistically significant association between gender and marital status on the one hand and treatment default on the other, age was significantly and positively associated with treatment default. Also, educated patients were less likely to default on treatment compared to their less educated counterparts. Similarly, employed patients and patients who resided in urban areas were more likely to default on treatment. Subsequently, the findings from the qualitative analysis revealed that poor service quality negatively influence ART uptake, adverse effects from ART negatively affect ART uptake and barriers / challenges to ART uptake as faced by patients, such as financial, psychological and physical barriers negatively affect the uptake of ART. Interventions aiming at dealing with these issues as identified and discussed in the study have to be developed and put in place to ensure success in the administration of ART in Mpumalanga province of South Africa. In conclusion, interventions that will support people on ART in wellness centres around the country should be developed and strengthened. Accordingly, all organizations should develop an HIV and AIDS workplace policy, that the Government of South Africa through the National Department of Health monitor and emphasize the importance of ensuring ART quality services in all HIV clinics around the country and finally interventions in terms of finances to meet the escalating food and transport demand for people on ART should be put in place to ensure that adherence is for a lifetime. There is also a need to undertake further research on socio-demographic and psychosocial factors affecting patients' adherence to ART utilizing the survival analysis, focusing on all wellness centres in South Africa.