The Perspectives of Users of Antiretroviral Therapy on Structural Barriers to Adherence in South Africa

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