Barriers and facilitators to Antiretroviral therapy adherence among clients with HIV in Hawassa, Southern Ethiopia: a qualitative grounded theory study

Abstract

ackground: Antiretroviral therapy adherence is widely recognized as a critical health promotion strategy for HIV positive individuals on therapy and it is the 'Achilles heel' of successful outcome. A better understanding of factors that influence clients‟ adherence to ART can improve to develop culturally appropriate and effective interventions which are in turn more likely to lead to successful and sustainable programs for clients with HIV/AIDS. Objectives: This study aims to explore clients‟ and health care professionals‟ views about factors that facilitate and constrain optimal adherence to ART among HIV Clients. Methods: In this qualitative study, grounded theory study design was used. The study was conducted in Hawassa town, Southern Ethiopia. A theoretical sampling method was employed, and the data were collected using non-participant observation and semi structured in-depth interviews by the principal investigator from February to April 2014 GC. Analysis: Simultaneous data collection and analysis was used and taped data and note were transcribed into Amharic then translated into English by the PI. The grounded theory approach was used for analyzing the data as a whole. The analysis began by using the constant comparison approach. The coding process was preceded by open coding, axial and selective coding. All of the codes used were inductive. To manage the overall coding process, Atlas.ti software was used. To assure the quality of the research findings the researcher was consider the different set of criteria to focusing on the credibility, dependability, transferability and Confirmability of the study. Result: Economic constraints, substance misuse, simply forgetting and being busy, fear of stigma and discrimination, pill burden and medication side effects were major reason for client being non-adherent. Disclosure of HIV status, using an adherence aid, prospects of living longer, social support, experiencing better health and trusting health workers emerged as facilitators of adherent to ART. Conclusion: Understanding barriers and facilitators to ART adherence can help in the design of an appropriate and targeted intervention. Policy-makers should develop appropriate social policy to promote adherence among ART-prescribed clients whilst Healthcare providers should address some of the practical and cultural issues around ART.