Nurses' Perceptions about Botswana Patients' Anti-Retroviral Therapy Adherence

ABSTRACT

Anti-retroviral drugs (ARVs) are supplied free of charge in Botswana. Lifelong adherence to anti-retroviral therapy (ART) is vital to improve the patient's state of well-being and to prevent the development of strains of the human immunodef ciency virus (HIV) that are resistant to ART. Persons with ART-resistant strains of HIV can spread these to other people; requiring more expensive ART with more severe side-effects and poorer health outcomes. The purpose of this exploratory; descriptive; qualitative study was to determine nurses' perspectives on Botswana patients' anti-retroviral therapy (ART) adherence; and to identify factors which could promote or hinder ART adherence. Four ART sites were randomly selected and all 16 nurses providing ART services at these sites participated in semi-structured interviews. These nurses indicated that patients' ART adherence was inf uenced by service-related and patient-related factors. Service-related factors included the inaccessibility of ART clinics; limited clinic hours; health workers' inability to communicate in patients' local languages; long waiting times at clinics and delays in being informed about their CD4 and viral load results. Nurses could not trace defaulters nor contact them by phone; and also had to work night shifts; disrupting nurse-patient relationships. Patient-related factors included patients' lack of education; inability to understand the significance of CD4 and viral load results; financial hardships; non-disclosure and non-acceptance of their HIV positive status; alcohol abuse; the utilisation of traditional medicines and side effects of ART. The challenges of lifelong ART adherence are multifaceted involving both patient-related and service-related factors. Supplying free ARVs does not ensure high levels of ART adherence