Page 291 - HIVMED_v21_i1.indb

Southern African Journal of HIV Medicine
ISSN: (Online) 2078-6751, (Print) 1608-9693
Page 1 of 10 Original Research

Understanding adherence in virally suppressed and

unsuppressed human immunodeficiency virus-positive

urban patients on second-line antiretroviral treatment

Authors: Background: Understanding antiretroviral therapy (ART) adherence may assist in designing
Siphamandla B. Gumede effective support interventions.
1,2
Willem D.F. Venter 1
Samanta T. Lalla-Edward 1 Objectives: This study elicited perspectives on how to promote treatment adherence from
virologically suppressed and unsuppressed patients receiving second-line ART.
Affiliations:
1 Ezintsha, a sub-division of Methods: This was a cross-sectional study conducted with randomly selected patients active
Wits Reproductive Health
and HIV Institute, University on second-line ART, from five public health facilities in the Johannesburg inner city. Data were
of the Witwatersrand, collected on demographics, clinical information, participant’s experiences and ART knowledge.
Johannesburg, South Africa Virological failure was defined as exceeding 1000 copies/mL.

2 Department of Results: The study sample comprised 149 participants; of which 47.7% (n = 71) were virally
Interdisciplinary Social unsuppressed and 69.1% (n = 103) were women; the median age of the participants was
Science, Public Health, 42 years (interquartile range [IQR] 36–47 years). Experiencing medication-related difficulties
Utrecht University, Utrecht, in taking second-line ART (p = 0.003), finding second-line regimen more difficult to take than
The Netherlands
a first-line regimen (p = 0.001) and experiencing side effects (p < 0.001) were all subjective
Corresponding author: predictors of virological failure. Participants’ recommendations for improving adherence
Siphamandla Gumede, included the introduction of a single tablet regimen (31.6%, n = 55), reducing the dosage to
[email protected]
once daily (26.4%, n = 46) and reducing the pill size for second-line regimen (4.0%, n = 7).
Dates: Conclusion: The results of this study highlight the importance of improving patients’
Received: 24 May 2020
Accepted: 13 June 2020 knowledge about adherence and motivation to continue ART use despite the persistence of
Published: 11 Aug. 2020 side effects and difficulties with taking medication.

How to cite this article: Keywords: adherence; viral load suppression; virological failure; antiretroviral therapy;
Gumede SB, Venter WDF, South Africa.
Lalla-Edward ST.
Understanding adherence in
virally suppressed and Introduction
unsuppressed human
immunodeficiency virus- The World Health Organization (WHO) defines adherence as the degree to which a patient is able
positive urban patients on
1
second-line antiretroviral to follow a treatment plan and take medication at prescribed times.
treatment. S Afr J HIV Med.
2020;21(1), a1107. https:// Factors that affect treatment adherence include changes in daily routines, forgetting to take
doi.org/10.4102/sajhivmed.
v21i1.1107 medication, side effects, depression, being away from home, comorbidity, lack of knowledge and
desire to take treatment. 2,3,4 In addition, patients experiencing financial constraints, social issues
Copyright: such as the fear of disclosure and lack of understanding of treatment benefits are more prone to
© 2020. The Authors.
5,6
Licensee: AOSIS. This work non-adherence to treatment and illnesses. Some studies have reported disclosure and relationship
is licensed under the with the person being disclosed to as predictors of adherence. 7,8
Creative Commons
Attribution License.
The South African government’s adherence promotion strategies include routine viral load
monitoring, adherence counselling, pill counting, adherence clubs and routine completion of
clinical stationery. 9,10,11 Despite all these antiretroviral therapy (ART) adherence strategies being
implemented, treatment failure amongst patients on first- and second-line ART remains an issue.
12
Lapses in ART medication adherence can lead to viral rebound with ongoing immunosuppression
and viral resistance. 1,13,14 However, not much is understood about the perspectives of patients
Read online: regarding adherence challenges. 15,16
Read online:
Scan this QR
Scan this QR
code with your
code with your Therefore, this study sought to describe and obtain perspectives on treatment adherence from two
smart phone or
smart phone or
mobile device
mobile device separate groups of patients on second-line therapy, those who were suppressed and those who
to read online.
to read online.
were not, to understand treatment-taking behaviour.
http://www.sajhivmed.org.za 283 Open Access