Data analysis was performed using Statistical Package for Social Sciences (SPSS) version 25.0. The analyzed data were presented in tables/percentages and diagrams. The study found that most respondents (73.3%) experienced side effects, especially in the first few months after starting treatment. The study revealed factors that contribute to nonadherence to ART, which include alcohol intake and side effects.
Therefore, the study recommends that an intervention to address alcohol intake and side effects should be carried out in Makhado Local Municipality. Map of Vhembe District………..15 Figure 4.1: Respondents who missed their medication by age category…………26 Figure 4.2: Have you ever experienced side effects……….27 Figure 4.3: Have you ever thought of stopping medication due to unpleasant effects ..28 Figure 4.4: Believe in prayer to cure HIV……….29 Figure 4.5 respondents thought of stopping medication when they were told that they were cured of HIV… …….30 Figure 4.5: What do you use as a treatment reminder………..32.
Introduction and Background
AIDS-related diseases have been largely driven by progress in sub-Saharan Africa, particularly Eastern and Southern Africa, with 53% of the world's people living with HIV (UNAIDS, 2019). Ojwang et al (2016) indicated that 57% of patients were documented as lost to follow-up (LTFU), of whom 26% were LTFU immediately after enrollment. South Africa's HIV epidemic remains the largest in the world with an estimated 7.7 million people living with HIV in 2018.
Mberi et al (2015) show that there is high loss to follow-up of patients after starting ART with a retention of 82% in the first 2 years and 55%. It is important to identify factors that reduce adherence to ART for patients to have sustained viral load suppression and live longer (Eyassu et al, 2016).
Problem statement
Rationale of the study
Significance of the study
Finally, the results of this study will also add to the existing knowledge on factors contributing to non-adherence to ARV treatment in adult patients in Vhembe district.
Aim of the study
Purpose
Objectives
Operational definition of terms
In this study, non-compliance means that a patient fails to keep appointments and follow prescribed treatment instructions. In this study, patient refers to a person who is HIV positive and in need of care from the healthcare provider. Viral load suppression – refers to an undetectable viral load for a person taking ART (AIDSinfo, 2015).
In this study, it refers to a viral load that is less than 100 copies/ml for a patient on ART.
Conclusion
Structure of the study
LITERATURE REVIEW
- Introduction
- Patient related factors contributing to non-adherence
- Socio demographic factors
- Socioeconomic factors
- Knowledge on ART adherence
- Psychosocial factors
- Side effects
- Socio-cultural factors
- Stigma and discrimination
- Family and social support
- Religious and cultural beliefs
- Health care system factors to improve on ART adherence
- Patient provider relationship
- Waiting time
- Pill reminder system
- M-Health
- Theoretical framework
- Conclusion
Socio-economic status such as poor living conditions, poverty, unemployment and financial difficulties are associated with poor adherence to ART (Mahlalela, 2014). Alcohol and drug use are associated with treatment nonadherence (Weitzman, Ziemnik, Huang & Levy, 2015). However, Daskalopoulou et al (2017) state that non-disclosure of HIV status is not associated with non-adherence to ART.
The Health Belief Model was originally developed as a systematic method to explain and predict preventive health behavior in the early 1950s by United States public health researchers (Skinner, Tiro, and Champion 2015). HBM focuses on the relationship between health behaviors, practices and utilization of health services. This includes patient-related factors and socio-cultural factors leading to ART non-adherence and health-related factors to improve ART adherence and conceptual framework.
RESEARCH METHODOLOGY
- Introduction
- Study design
- Study area
- Study population
- Sample size
- Sampling method
- Criteria of inclusion
- Exclusion criteria
- Measurement instrument
- Validity and Reliability
- Validity
- Reliability
- Pre-test
- Method of data collection
- Data analysis
- Ethical considerations
- Permission to conduct the study
- Informed consent
- Voluntary participation
- Confidentiality and Privacy
- Protection of participants from any harm
- Dissemination of the results
- Conclusion
Burns and Groove (2010) state that study population refers to the entire group of individuals or subjects in which the researcher is interested in conducting a study. The researcher selected the Kulani Gateway clinic as a pilot site and administered the questionnaire to ten respondents before starting the actual project. The researcher presented the questionnaire to the supervisors, department seminars, and higher degree committees to ensure facial validity.
The researcher tested the instrument to make sure it was measuring what it was supposed to measure. The clinic is located next to the researcher's study area, and it offers treatment to HIV-positive patients. The purpose of the pre-test was to adapt the questionnaire so that the researcher could make corrections where necessary, guided by the participants' comments.
The researcher visited hospitals for 6 working days to collect data; two days per hospital. Respondents completed the questionnaires while the researcher was on hand to clarify matters for the respondents. The researcher submitted the proposal to the School of Public Health and the Higher Degrees Committee of the University of Venda for quality assurance and approval.
The researcher ensured that they knew that participation in the study was voluntary. After completing the documents, they placed them in separate envelopes, sealed them, and returned them to the researcher. The researcher will also present the findings to the Vhembe District HIV/AIDS, STI and TB forums.
RESULTS
- Introduction
- Patient related factors contributing to non-adherence to ART
- Demographic characteristics
- Psychosocial status
- Socio-cultural factors contributing to non-adherence
- Believing in prayer to cure HIV
- Disclosure of HIV status
- Factors to improve adherence to ART
- Hours spent at the clinic
- System used as a pill reminder
- Counselling received before ART started
- Decanting strategies
- Conclusion
Of the 37 respondents who had started treatment in less than six months, the respondents adhered to the treatment and 9 (24.4%) of the respondents did not adhere to the treatment. It is noted that there is a significant association between the treatment start date and non-adherence to ART (P=0.000). 57 (25.3%) of the respondents indicated that they had taken alcohol, and only two (0.9%) respondents drank alcohol every day.
It is noted that a significant association was observed between taking alcohol and forgetting to take treatment (p=0.000). The results shown in Figure 4.3 indicate that among 165 (73%) respondents who experienced side effects thought about stopping treatment and 49 (30%) did not think about stopping medication. Not disclosing one's HIV status and religious background are some sociocultural factors that contribute to non-adherence to a treatment regimen.
One hundred and thirty-three respondents (59%) believe that prayer can cure HIV, while 92 (41%) respondents do not believe that prayer can cure HIV. Of the 133 who believed that prayer could cure HIV, only respondents considered stopping their medication when told they were cured and said they would never stop taking their medication, as shown in the figure 4.5. Percentage of respondents who considered leaving treatment after being told they were cured.
In Table 4.6, a significant relationship was observed between disclosing HIV status and missing treatment (p=0.012). One hundred and seventy-four (77.3%) respondents spent less than one hour in the facility, while only five (2.2%) respondents reported spending 3 to 4 hours in the facility. Two hundred and seven (92%) respondents indicated that they received counseling before entering treatment.
DISCUSSION AND RECOMMENDATION
- Introduction
- Demographic characteristics
- Psychosocial factors
- Socio cultural factors contributing to non-adherence
- Strategies to improve on adherence
- Long waiting time
- Limitations of the study
- Conclusion
- Recommendations
Factors contributing to non-compliance with ART in this study include alcohol consumption and side effects. Barriers to following antiretroviral treatment at a regional hospital in Vredenburg, Western Cape, South Africa. Reasons for poor adherence to antiretroviral therapy (ART) among young female (15-24 years) HIV/AIDS patients in the Oshakati district (dissertation, Stellenbosch: Stellenbosch University).
Adherence to antiretroviral therapy among HIV and AIDS patients at Kwa-Thema Clinic in Gauteng Province, South Africa. Text message intervention models to promote antiretroviral therapy (ART) adherence: a meta-analysis of randomized controlled trials. Adherence to antiretroviral therapy (ART) in Yaoundé-Cameroon: association with opportunistic infections, depression, ART regimen and side effects.
Factors associated with adherence to antiretroviral therapy (ART) among adults living with HIV attending clinical care, Eastern Ethiopia. Rates and predictors of non-adherence to antiretroviral therapy among HIV-positive individuals in Kenya: results from the second Kenya AIDS indicator survey, (2012). Factors affecting adherence to antiretroviral therapy among seropositive clients at Mbaghathi-Nairobi District Hospital (Doctoral dissertation, University of Nairobi).
Adherence to antiretroviral therapy and its effect on the survival of HIV-infected individuals in Jharkhand, India. Factors associated with non-adherence to antiretroviral therapy in adults with AIDS during the first six months of treatment in Salvador, Bahia State, Brazil. Usefulness of mobile communication devices as a tool to improve antiretroviral treatment compliance in HIV patients.
Questionnaire
18 (tick one) Xana u nwa mirhi yin'wana ku engetela eka leyi nyikiwaka etliliniki? 39 Hi nkarhi wa ku burisana, xana u byeriwe hi switandzhaku na ku tirhisana ka mirhi leyi. Hlamula swivutiso leswi hi vukheta hi ku hlawula nhlamulo leyi faneleke na ku tsala nhlamuselo yo koma laha swi faneleke.
39 Xana u byeriwe hi switandzhaku na ku tirhisana ka mirhi leyi hi nkarhi wa ku burisana?
Consent form
Respondent consent
U rhambiwa ku hlanganyela eka dyondzo leyi hikuva u wela eka ntlawa wa malembe lama dyondziweke. U ntshunxekile kumbe u na mfanelo yo kombela ku huma eka dyondzo leyi nkarhi wihi na wihi naswona vuhlayiseki bya ndyangu wa wena kumbe vuxaka bya wena na ntlawa wa wena wa nhlayiso wa rihanyo a byi nge ekhombyeni. A wu nge vuyeriwi hi ku kongoma, kambe ku nghenelela ka wena ku ta nyika vuxokoxoko lebyi nga pfunaka ku tumbuluxa maendlelo lama nga pfunaka vanhu lava hanyaka na HIV ku nwa tiphilisi leti tinyiketeleke ku lawula nhlayo ya vona ya xitsongwatsongwana, leswi yisaka eka rihanyo ro antswa.
Hi kombela mi nga kanakani ku vutisa swivutiso swihi na swihi mayelana na ndzavisiso lowu kumbe mayelana no nghenelela eka ndzavisiso lowu, kumbe u nga tlhela u tihlanganisa na Manana Bridget Nhlongolwane Nkatingi, Yunivhesiti ya Venda, Ndzawulo ya Rihanyo ra Vaaki hi riqingho eka adirese ya email leyi landzelaka [email protected]. Ndzi tivisa leswaku ndzi tivisiwile hi mulavisisi, Nkatingi Bridget Nhlongolwane, hi muxaka, maendlelo, mbuyelo na switandzhaku swa ndzavisiso lowu – Research Ethics Clearance Number: SHS/18/PH/14/1 Ndzi hlayile mahungu lama tsariweke laha henhla ( papila ra vuxokoxoko bya mutekaxiave) ri amukerile, ri hlayile no twisisa hi ndzavisiso lowu.
Ndzi tsundzuxiwile leswaku mbuyelo wa ndzavisiso lowu, ku katsa na vuxokoxoko bya mina mayelana na rimbewu, malembe, siku ra ku velekiwa, letere ro sungula ra vito ra mina na mbuyelo wa ku kumiwa ka mina swi ta katsiwa handle ko ndzi paluxela mbuyelo wa ndzavisiso lowu. . . . Loko hi tekela enhlokweni swilaveko swa ndzavisiso, ndza pfumela leswaku datha leyi hlengeletiweke hi nkarhi wa ndzavisiso lowu yi nga ha dawunilodiwile hi mulavisisi. Ndzi nga ha hoxa mpfumelelo wa mina na ku nghenelela eka dyondzo leyi nkarhi wihi na wihi handle ko voniwa nandzu kumbe ku sola.
Ndzi vile na nkarhi lowu eneleke wo vutisa swivutiso na ku hlambanya (hi ku olova) leswaku ndzi lulamile ku hlanganyela eka dyondzo leyi. Ndza swi twisisa leswaku swikumiwa swihi na swihi swa nkoka hi nkarhi wa ndzavisiso lowu leswi nga khumbaka ku nghenelela ka mina swi ta tivisiwa eka mina. Mina (Bridget Nhlongolwane Nkatingi) ndzi tiyisisa leswaku mutekaxiave u hlamuseriwile hi vuxokoxoko maendlelo na swihlawuhlawu leswi nga vaka kona mayelana na ndzavisiso lowu.
Athical clearance
Approval letter from limpopo department of health
Approval letter from vhembe district
