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Logo of bmcphBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Public Health
 
BMC Public Health. 2012; 12: 716.
Published online Aug 30, 2012. doi:  10.1186/1471-2458-12-716
PMCID: PMC3488585
Determinants of antiretroviral therapy adherence in northern Tanzania: a comprehensive picture from the patient perspective
Ramsey A Lyimo,corresponding author1 Marijn de Bruin,2 Jossy van den Boogaard,3 Harm J Hospers,4 André van der Ven,3 and Declare Mushi5
1Kilimanjaro Clinical Research Institute, Kilimanjaro Christian Medical Centre, P.O.Box 2236, Moshi, Tanzania
2Department of Communication Science, Wageningen University, Wageningen, The Netherlands
3Department of General Internal Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, Nijmegen, 6500 HB, The Netherlands
4Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
5Community Health Department, Kilimanjaro Christian Medical College, P.O.Box 2240, Moshi, Tanzania
corresponding authorCorresponding author.
Ramsey A Lyimo: rlyimo7/at/yahoo.com; Marijn de Bruin: marijn.debruin/at/wur.nl; Jossy van den Boogaard: jossyvandenboogaard/at/gmail.com; Harm J Hospers: h.hospers/at/maastrichtuniversity.nl; André van der Ven: A.vanderVen/at/aig.umcn.nl; Declare Mushi: declbety/at/yahoo.com
Received December 10, 2011; Accepted August 20, 2012.
Abstract
Background
To design effective, tailored interventions to support antiretroviral therapy (ART) adherence, a thorough understanding of the barriers and facilitators of ART adherence is required. Factors at the individual and interpersonal level, ART treatment characteristics and health care factors have been proposed as important adherence determinants.
Methods
To identify the most relevant determinants of adherence in northern Tanzania, in-depth interviews were carried out with 61 treatment-experienced patients from four different clinics. The interviews were ad-verbatim transcribed and recurrent themes were coded.
Results
Coding results showed that the majority of patients had basic understanding of adherence, but also revealed misconceptions about taking medication after alcohol use. Adherence motivating beliefs were the perception of improved health and the desire to live like others, as well as the desire to be a good parent. A de-motivating belief was that stopping ART after being prayed for was an act of faith. Facilitators of adherence were support from friends and family, and assistance of home based care (HBC) providers. Important barriers to ART adherence were the use of alcohol, unavailability of food, stigma and disclosure concerns, and the clinics dispensing too few pills. Strategies recommended by the patients to improve adherence included better Care and Treatment Centre (CTC) services, recruitment of patients to become Home Based Care ( HBC) providers, and addressing the problem of stigma through education.
Conclusion
This study underscores the importance of designing tailored, patient-centered adherence interventions to address challenges at the patient, family, community and health care level.
Articles from BMC Public Health are provided here courtesy of
BioMed Central