Abstract
BACKGROUND
The recent scale-up of antiretroviral therapy (ART) coverage in resource-limited settings has greatly improved
access to treatment. However, increasing numbers of patients are failing first- and second-line ART.
OBJECTIVE
To examine factors affecting adherence to second-line ART from the perspective of clinic staff and patients, assessing
both individual and structural perceived barriers.
METHODS
Research was conducted at a large primary care tuberculosis (TB)/HIV clinic in Khayelitsha, a peri-urban township
in Cape Town, South Africa. Participants were drawn from a Médecins Sans Frontières-run programme to support patients
failing second-line ART. A qualitative research approach was used, combining multiple methodologies including key informant
interviews with staff (n=11), in-depth interviews with patients (n=10) and a Photovoice workshop (n=11). Responses and
photographs were coded by content; data were transformed into variables and analysed accordingly.
RESULTS
Staff identified drinking, non-disclosure, not using condoms and pill fatigue as barriers to ART adherence, while
patients identified side-effects, not using condoms and a lack of understanding concerning medication timing. With respect
to service delivery, staff identified a need for continued counselling and educational support following ART initiation. Patients
were concerned about missing medical records and poor staff attitudes in the clinic.
CONCLUSION
These findings identify discrepancies between provider and patient perceptions of barriers to, and facilitators of
adherence, as well as of service delivery solutions. This highlights the need for on-going counselling and education following
ART initiation, improved quality of counselling, and improved methods to identify and address specific barriers concerning
medication adherence
