Barriers to highly active antiretroviral therapy amongst HIV-infected adolescents in a government hospital in Botswana

Abstract

The emergence of the Human Immuno-Deficiency Virus (HIV) and Acquired Immuno-Deficiency Syndrome (AIDS) has resulted in many children being perinatally-infected. Some die before reaching adolescence, while others survived into adolescence due to the introduction of Highly Active Antiretroviral Therapy (HAART). Amongst countries of sub-Saharan Africa, Botswana has the highest estimated prevalence rate of HIV and AIDS which is 18.5% of a total population of 2 038 228. In 2002, Botswana became the first country in sub-Saharan Africa to launch a free national HAART programme in the public health sector. The country has achieved more than a 96% coverage rate of HAART. Despite availability of HAART, adolescence is a complex developmental phase marked with psychological, behavioural, physiological and cognitive changes. Hence, the goal of the study has been to identify barriers to HAART adherence amongst HIV-infected adolescents in a government hospital, in Botswana. A qualitative research approach and a phenomenological research design have been utilised to explore and describe factors that inhibit HIV-infected adolescents from adhering appropriately to HAART. The study participants are twelve HIV-infected adolescents (males and females) aged 13 to 17 years who receive HAART from a government hospital in Botswana. Simple random sampling had been used to select these study participants. Unstructured, one-on-one interviews had been conducted utilising an interview schedule and the data that had been collected from the interviews has been transcribed and thematically analysed using Tesch s framework. A bio-ecological perspective has been applied to enhance understanding of this phenomenon. The following themes emerged from the study: knowledge about HIV and AIDS and the importance of HAART adherence, contextualising and conceptualising HAART adherence amongst adolescents, factors contributing towards non-adherence to HAART amongst HIV-infected adolescents, coping strategies and recommendations. The study findings reveal that participants displayed adequate knowledge regarding HIV and AIDS, its transmission, prevention and treatment. However, participants showed inadequate knowledge regarding the myths of HIV and AIDS. The study findings reveal further that participants are knowledgeable of the benefits of HAART adherence, methods that are being utilised to assess adherence and consequences of non-adherence. Hospital, school, home, radio, television, pamphlets, teen club and church are the major sources of information for the knowledge displayed. The results of the study show that a significant number of participants started treatment at a younger age and have been on treatment for lengthier periods. The main barriers to HAART adherence are individually-related factors, regimen or medication side effects, social stigma from school and community, and lengthy waiting times in the health facility during medication refills. However, disclosure of HIV positive status, support from family, teen club or peers, hospital, school, church and various individual strategies were utilised as coping mechanisms. Moreover, majority of the participants were adamant that continuous education on the importance of HAART adherence by healthcare workers and caregivers is essential. They also added that medication supervision is a key strategy in enhancing adherence amongst non-adherent HIV-infected adolescents. Recommendations include the imperativeness of a multi-sectoral approach towards strengthening education on HIV and AIDS, including the importance of HAART adherence, as well as addressing stigma and discrimination surrounding HIV and AIDS. Last of all, future research should include caregivers and healthcare workers particularly, in studies of this nature to strengthen the findings. It should also consider the effectiveness of initiatives that have been outlined to promote HAART adherence.