TY - JOUR
T1 - Barriers to Antiretroviral Adherence for Patients Living with HIV Infection and AIDS in Botswana
AU - Weiser, Sheri
AU - Wolfe, William
AU - Bangsberg, David
AU - Thior, Ibou
AU - Gilbert, Peter
AU - Makhema, Joseph
AU - Kebaabetswe, Poloko
AU - Dickenson, Dianne
AU - Mompati, Kgosidialwa
AU - Essex, Max
AU - Marlink, Richard
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2003/11/1
Y1 - 2003/11/1
N2 - Background: Botswana has the highest rate of HIV infection in the world, estimated at 36% among the population aged 15-49 years. To improve antiretroviral (ARV) treatment delivery, we conducted a cross-sectional study of the social, cultural, and structural determinants of treatment adherence. Methods: We used both qualitative and quantitative research methodologies, including questionnaires and interviews with patients receiving ARV treatment and their health care providers to elicit principal barriers to adherence. Patient report and provider estimate of adherence (≥95% doses) were the primary outcomes. Results: One hundred nine patients and 60 health care providers were interviewed between January and July 2000; 54% of patients were adherent by self-report, while 56% were adherent by provider assessment. Observed agreement between patients and providers was 68%. Principal barriers to adherence included financial constraints (44%), stigma (15%), travel/migration (10%), and side effects (9%). On the basis of logistic regression, if cost were removed as a barrier, adherence is predicted to increase from 54% to 74%. Conclusions: ARV adherence rates in this study were comparable with those seen in developed countries. As elsewhere, health care providers in Botswana were often unable to identify which patients adhere to their ARV regimens. The cost of ARV therapy was the most significant barrier to adherence.
AB - Background: Botswana has the highest rate of HIV infection in the world, estimated at 36% among the population aged 15-49 years. To improve antiretroviral (ARV) treatment delivery, we conducted a cross-sectional study of the social, cultural, and structural determinants of treatment adherence. Methods: We used both qualitative and quantitative research methodologies, including questionnaires and interviews with patients receiving ARV treatment and their health care providers to elicit principal barriers to adherence. Patient report and provider estimate of adherence (≥95% doses) were the primary outcomes. Results: One hundred nine patients and 60 health care providers were interviewed between January and July 2000; 54% of patients were adherent by self-report, while 56% were adherent by provider assessment. Observed agreement between patients and providers was 68%. Principal barriers to adherence included financial constraints (44%), stigma (15%), travel/migration (10%), and side effects (9%). On the basis of logistic regression, if cost were removed as a barrier, adherence is predicted to increase from 54% to 74%. Conclusions: ARV adherence rates in this study were comparable with those seen in developed countries. As elsewhere, health care providers in Botswana were often unable to identify which patients adhere to their ARV regimens. The cost of ARV therapy was the most significant barrier to adherence.
KW - Adherence
KW - Africa
KW - Botswana
KW - Compliance
KW - Highly active antiretroviral therapy
KW - Treatment barriers
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U2 - 10.1097/00126334-200311010-00004
DO - 10.1097/00126334-200311010-00004
M3 - Article
C2 - 14600572
AN - SCOPUS:0242496506
VL - 34
SP - 281
EP - 288
JO - Journal of Acquired Immune Deficiency Syndromes
JF - Journal of Acquired Immune Deficiency Syndromes
SN - 1525-4135
IS - 3
ER -