Knowledge, attitudes, beliefs and adherence to antiretroviral therapy among people living with HIV/AIDS receiving treatment at Shongwe Hospital in Nkomazi region, Mpumalanga province
Background: HIV and AIDS is one of the major public health problems facing South Africa today. In 2005, it was estimated that 5.54 million people were living with HIV in South Africa, which means that 18.8% of the population between the ages of 15 – 49 years are infected with HIV. This makes South Africa the developing country worst affected by the HIV pandemic. The severity of the HIV epidemic is closely linked to poverty and other socio-economic factors. The National Department of Health of South Africa launched the National Operational Plan for Comprehensive HIV and AIDS management, treatment, care, and support in 2007 to ensure that ART is freely available in the public health sector. It is estimated that by mid-2008 approximately 568, 000 HIV infected patients were receiving ART at South African hospitals. Suboptimal adherence to ART is pervasive despite specific protocols to prepare patients for long-term adherence prior to treatment initiation. Known barriers to ART adherence have been categorized as patient, socio-economic, service, therapy/regimen and communityrelated factors. Effective delivery of ART services requires an understanding of patients’ knowledge, attitudes, and beliefs about ART and how these influence their adherence. Aim: The aim of the study was to assess adherence to antiretroviral therapy and knowledge, attitudes and beliefs about ART among people on ART at Shongwe hospital in Nkomazi region in Mpumalanga province, South Africa. Methodology: A descriptive, cross-sectional survey was conducted among 184 patients receiving ART at Shongwe hospital in Mpumalanga. Data was collected through selfiv administration and face-to-face interviews. Quantitative data was analysed using the SPSS version 16.0 and for stratification Epi-Info version 3.4.1 was used. Results: All participants were on first line regimens: lamivudine/stavudine/stocrine or efivarenz (65.6%); and lamivudine/stavudine/nevirapine (34%). Self-reported adherence was high - 92.4% and 84.2% of participants reported optimal adherence over the previous two days and seven days, respectively. Disclosure of HIV status and being on ART was high among the respondents (97% and 97.3%) respectively. The most common barriers to missing doses were problems travelling to the clinic (22.3%), forgetting (19.6%), and sleeping away from home (18.5%). There was significant association between participants knowing that “missing doses of ART leads to disease progression”, and ART adherence on two day recall (p=0.00) and seven day recall (p=0.02). There was a significant association between disclosure of HIV status and ART adherence on two day recall (p=0.01). Significantly more participants who disclosed being on ART (98.2%) reported optimal adherence over the previous two days (p = 0.00) and seven days (p = 0.00) compared to those who did not disclose being on ART. Participants who reported forgetfulness were 76% less likely (95% CI: 0.09-0.65) and 92% less likely (95% CI: 0.04 – 0.17) to have optimal adherence over two and seven days, respectively, than participants who did not report forgetfulness to be a barrier. Conclusion: Adherence levels in Nkomazi region are to be comparable with those in other regions in South Africa, despite the fact that participants were facing financial constraints and high unemployment rates. These study findings emphasize the need for strengthening communication between patients and health care providers, and the need for overcoming access barriers related to the services, forgetfulness and sleeping away from home.