‘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

Bibliographic Data

ID19507602
AuthorsJacqueline Ndirangu (0000-0001-8346-7359, Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA, corresponding author), Margaret W Gichane (0000-0001-8499-154X, Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA), F A Browne (0000-0002-4230-2096, Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA), Courtney Peasant Bonner (0000-0001-6983-2698, University of North Carolina at Chapel Hill), William A Zule (0000-0002-6781-1030, Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA), Erin N Cox (Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA), Kevin M Smith (0000-0002-6736-4779, Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill North Carolina USA), Tara Carney (0000-0001-5400-0565, Alcohol, Tobacco and Other Drug Research Unit South African Medical Research Council Tygerberg South Africa), W M Wechsberg (0000-0002-5146-6463, Substance Use, Gender, and Applied Research Program, RTI International Research Triangle Park North Carolina USA)
Year2022
Volume25
Issue2
Pages754-763
Publication date2022-04-01
Open AccessYes
TypeARTICLE
VenueHealth Expectations (JOURNAL)
Journal identifiersISSN: 1369-6513 • E-ISSN: 1369-7625
PublisherWiley (PUBLISHER • GB)
DOI10.1111/hex.13422
PMID35060260
OpenAlexW4206735946
LanguageEN
Citations received4
References cited56

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

Environmental health · Family medicine · Focus group · Interpersonal communication · Intrapersonal communication · Population · Psychiatry · Psychological intervention · Qualitative research · Social stigma · Thematic analysis · Adolescent Sexual and Reproductive Health · HIV, Drug Use, Sexual Risk · HIV/AIDS Research and Interventions · Medicine · Nursing · Psychology · Social Psychology · Gerontology

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