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. 2022 Apr;25(2):754-763.
doi: 10.1111/hex.13422. Epub 2022 Jan 21.

'We have goals but [it is difficult]'. Barriers to antiretroviral therapy adherence among women using alcohol and other drugs living with HIV in South Africa

Jacqueline W Ndirangu  1 , Margaret W Gichane  1 , Felicia A Browne  1   2 , Courtney P Bonner  1   2 , William A Zule  1 , Erin N Cox  1 , Kevin M Smith  2 , Tara Carney  3   4 , Wendee M Wechsberg  1   2   5   6
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'We have goals but [it is difficult]'. Barriers to antiretroviral therapy adherence among women using alcohol and other drugs living with HIV in South Africa

Jacqueline W Ndirangu et al. Health Expect. 2022 Apr.

Abstract

Background: Women living with HIV who misuse alcohol and live in economically disadvantaged settings in South Africa experience a multitude of contextual barriers as they navigate the HIV care continuum. The Women's Health CoOp (WHC), a brief, woman-focused, behavioural, evidence-based intervention, has been shown to be effective in reducing heavy drinking and improving HIV-related outcomes among this key population. However, these women face other broader socioecological barriers to antiretroviral therapy (ART) adherence.

Methods: The WHC was implemented in a modified, stepped-wedge implementation science trial in public health clinics and substance use treatment programmes in Cape Town, South Africa. A qualitative substudy was conducted to explore barriers to HIV treatment adherence among women enrolled in this trial. Eight focus group discussions were conducted with 69 participants 6 months after completion of the WHC workshops. Focus groups were audio-recorded (with consent), transcribed verbatim and analysed using a thematic approach.

Results: The mean age of the participants was 33 years and the mean self-reported number of drinks per day was 13. The main contextual factors influencing participants' ART adherence were intrapersonal-level factors (substance use, financial constraints, food insecurity; community-level factors (anticipated and enacted stigma, community violence) and institutional-level factors (patient-provider relationships, health facility barriers, environmental stigma).

Conclusion: Comprehensive interventions addressing the contextual barriers and unique challenges faced by women who misuse alcohol in low-resource settings that intersect with HIV treatment nonadherence should be implemented in tandem with successful biobehavioural HIV interventions for long-term effectiveness and sustainability.

Patient or public contribution: Our South African community collaborative board has been involved throughout this study; participants and clinic staff voices have been essential in our interpretation of these findings.

Keywords: HIV care continuum; alcohol and other drugs (AOD); antiretroviral therapy (ART); gender-focused; implementation science; socioecological barriers.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Primary reasons identified for nonadherence to antiretroviral therapy among women living with HIV
See this image and copyright information in PMC

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