Near-perfect adherence to
antiretroviral therapy (ART) is required to achieve the best possible
prevention and treatment outcomes. Yet, there have been particular concerns
about the challenges of adherence among patients living in resource-limited
settings in sub-Saharan Africa.
The primary objective of this study was to
explore adherence in a low-resourced, rural community of high HIV prevalence in
South Africa and to identify specific individual and structural factors that
can either challenge or support adherence in this context. We applied digital
stories as a qualitative research tool to gain insights into personal contexts
of HIV and ART adherence. Through an inductive thematic analysis of twenty
story texts, soundtracks and drawings, we explored experiences, understandings,
and contexts of the participants and identified potential barriers and
facilitators for those on lifelong treatment.
We found that many of the stories
reflected a growing confidence in the effectiveness of ART, which should be
viewed as a key facilitator to successful adherence since this attitude can
promote disclosure and boost access to social support. Nevertheless, stories
also highlighted the complexity of the issues that individuals and households
face as they deal with HIV and ART in this setting and it is clear that an
overburdened local healthcare system has often struggled to meet the demands of
a rapidly expanding epidemic and to provide the necessary medical and emotional
support.
Our analysis suggests several opportunities for further research and
the design of novel health interventions to support optimal adherence. Firstly,
future health promotion campaigns should encourage individuals to test
together, or at least accompany each other for testing, to encourage social
support from the outset.
Additionally, home-based testing and ART club
interventions might be recommended to make it easier for individuals to adhere
to their treatment regimens and to provide a sense of support and solidarity.
Below: Participant drawing depicting the pain of disclosure
Below: Participant drawing depicting the pain of disclosure
Full article at: http://goo.gl/th5yAY
By:
Africa Centre for Population Health, University of
KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
School of Education, University of KwaZulu-Natal, Durban,
KwaZulu Natal, South Africa
Department of Clinical Research, London School of Hygiene
and Tropical Medicine, London, United Kingdom
Independent digital storytelling practitioner and
researcher, Digital storytelling South Africa, Cape Town, South Africa
Department of Global Health and Population, Harvard T.H.
Chan School of Public Health, Boston, Massachusetts, United States of America
School of Laboratory Medicine and Medical Sciences, College
of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
Honorary, Research Department of Infection, University College
London (UCL), London, United Kingdom
Research Department of Infection, University College London
(UCL), London, United Kingdom
Anthropology and Health, London School of Hygiene and
Tropical Medicine, London, United Kingdom
More at: https://twitter.com/hiv insight
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