“I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry

Emmy Metta; William Yonathan; Melkizedeck Leshabari

doi:doi:10.11648/j.ijhpebs.20210701.12

| Peer-Reviewed

“I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry

Emmy Metta, William Yonathan, Melkizedeck Leshabari

Published in International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 7, Issue 1)

Received: 1 March 2021 Accepted: 12 March 2021 Published: 22 March 2021

Views: Downloads:

Download PDF

Share This Article

Twitter
Linked In
Facebook

Abstract

Background: Continuing use of ART treatments is reported to improve health and health outcomes of people living with HIV. However, adherence to ART prescriptions is generally a challenge and many people default from HIV care and treatment. This study assessed reasons for ART treatment default among adults living with HIV in Tunduru district Tanzania. Methods: We conducted a qualitative cross-sectional study between January and February 2018. Ten key informants who had defaulted from HIV care and treatment for five or more months were engaged in in-depth interviews on reasons behind defaulting. Thematic analysis using NVivo was conducted to identify emerging themes. Results: Reasons for defaulting from ART treatments which emerged include being tired of using the ART medications for a long time, not experiencing HIV related symptoms, fear of stigma and shame of being known to use ART, inadequate food, fear of side effects and use of local herbs as alternative. Other reasons include long distance to the health facilities and long waiting time for the services at the facility. Conclusion: Reasons for defaulting from HIV treatment and care among adults are multifaceted in nature requiring multifaceted efforts to address them if the gains intended from the use of ART are to be achieved and sustained.

Published in	International Journal of HIV/AIDS Prevention, Education and Behavioural Science (Volume 7, Issue 1)
DOI	10.11648/j.ijhpebs.20210701.12
Page(s)	8-14
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2021. Published by Science Publishing Group

Keywords

ART, Default, Non-adherence, Tunduru, Tanzania

References

[1]	UNAIDS., 2015. Understanding -Track: Accelerating Actions to End the AIDS Epidemic by 2030. Accessed on 22 November, 2020 at https://www.unaids.org/sites/default/files/media_asset/201506_JC2743_Understanding_FastTrack_en.pdf.
[2]	Adeniyi OV, Ajayi AI, Ter Goon D, Owolabi EO, Eboh A, Lambert J. Factors affecting adherence to antiretroviral therapy among pregnant women in the Eastern Cape, South Africa. BMC infectious diseases. 2018; 18 (1): 175.
[3]	Chalker J, Andualem T, Minzi O, Ntaganira J, Ojoo A, Waako P, et al. Monitoring adherence and defaulting for antiretroviral therapy in 5 east African countries: an urgent need for standards. Journal of the International Association of Physicians in AIDS Care. 2008; 7 (4): 193-9.
[4]	Rachlis B, Ahmad F, van Lettow M, Muula AS, Semba M, Cole DC. Using concept mapping to explore why patients become lost to follow up from an antiretroviral therapy program in the Zomba District of Malawi. BMC health services research. 2013; 13 (1): 1-11.
[5]	Van Cutsem G, Ford N, Hildebrand K, Goemaere E, Mathee S, Abrahams M, et al. Correcting for mortality among patients lost to follow up on antiretroviral therapy in South Africa: a cohort analysis. PLoS One. 2011; 6 (2): e14684.
[6]	Sahay S, Reddy KS, Dhayarkar S. Optimizing adherence to antiretroviral therapy. The Indian journal of medical research. 2011; 134 (6): 835.
[7]	DiMatteo MR. Variations in patients' adherence to medical recommendations: a quantitative review of 50 years of research. Medical care. 2004: 200-9.
[8]	Fernandez-Lazaro CI, García-González JM, Adams DP, Fernandez-Lazaro D, Mielgo-Ayuso J, Caballero-Garcia A, et al. Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study. BMC family practice. 2019; 20 (1): 132.
[9]	Malta M, Magnanini MM, Strathdee SA, Bastos FI. Adherence to antiretroviral therapy among HIV-infected drug users: a meta-analysis. AIDS and Behavior. 2010; 14 (4): 731-47.
[10]	Achappa B, Madi D, Bhaskaran U, Ramapuram JT, Rao S, Mahalingam S. Adherence to antiretroviral therapy among people living with HIV. North American journal of medical sciences. 2013; 5 (3): 220.
[11]	Enane LA, Vreeman RC, Foster C. Retention and adherence: global challenges for the long-term care of adolescents and young adults living with HIV. Current Opinion in HIV and AIDS. 2018; 13 (3): 212-9.
[12]	Heestermans T, Browne JL, Aitken SC, Vervoort SC, Klipstein-Grobusch K. Determinants of adherence to antiretroviral therapy among HIV-positive adults in sub-Saharan Africa: a systematic review. BMJ global health. 2016; 1 (4): e000125.
[13]	Global information and education on HIV and AIDS; Accessed on 12th December, 2020 at https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/tanzaniahttps://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/tanzania.
[14]	Mannheimer S, Friedland G, Matts J, Child C, Chesney M, AIDS TBCPfCRo. The consistency of adherence to antiretroviral therapy predicts biologic outcomes for Human Immunodeficiency Virus—infected persons in clinical trials. Clinical infectious diseases. 2002; 34 (8): 1115-21.
[15]	Braun V, Clarke V. What can “thematic analysis” offer health and wellbeing researchers? International journal of qualitative studies on health and well-being. 2014; 9.
[16]	Weiser S, Wolfe W, Bangsberg D, Thior I, Gilbert P, Makhema J, et al. Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. JAIDS-HAGERSTOWN MD- 2003; 34 (3): 281-8.
[17]	Musumari PM, Feldman MD, Techasrivichien T, Wouters E, Ono-Kihara M, Kihara M. “If I have nothing to eat, I get angry and push the pills bottle away from me”: A qualitative study of patient determinants of adherence to antiretroviral therapy in the Democratic Republic of Congo. AIDS care. 2013; 25 (10): 1271-7.
[18]	Koole O, Denison JA, Menten J, Tsui S, Wabwire-Mangen F, Kwesigabo G, et al. Reasons for missing antiretroviral therapy: results from a multi-country study in Tanzania, Uganda, and Zambia. PloS one. 2016; 11 (1): e0147309.
[19]	McGuire M, Munyenyembe T, Szumilin E, Heinzelmann A, Le Paih M, Bouithy N, et al. Vital status of pre-ART and ART patients defaulting from care in rural Malawi. Tropical Medicine & International Health. 2010; 15: 55-62.
[20]	Dessie G, Wagnew F, Mulugeta H, Amare D, Jara D, Leshargie CT, et al. The effect of disclosure on adherence to antiretroviral therapy among adults living with HIV in Ethiopia: a systematic review and meta-analysis. BMC infectious diseases. 2019; 19 (1): 1-8.
[21]	Tshweneagae GT, Oss VM, Mgutshini T. Disclosure of HIV status to sexual partners by people living with HIV. curationis. 2015; 38 (1): 1-6.
[22]	Yonah G, Fredrick F, Leyna G. HIV serostatus disclosure among people living with HIV/AIDS in Mwanza, Tanzania. AIDS research and therapy. 2014; 11 (1): 1-5.
[23]	Forsythe S, Lee B, Tarimo K, Silvan B, Balampama M, Chitty J, Bowsky S. HIV treatment support services in Tanzania: a cost and efficiency analysis at facility and community levels. African Journal of AIDS Research. 2019 Dec 6; 18 (4): 306-14.
[24]	Chirambo L, Valeta M, Kamanga TMB, Nyondo-Mipando AL. Factors influencing adherence to antiretroviral treatment among adults accessing care from private health facilities in Malawi. BMC public health. 2019; 19 (1): 1-11.
[25]	Byakika-Tusiime J, Polley EC, Oyugi JH, Bangsberg DR. Free HIV antiretroviral therapy enhances adherence among individuals on stable treatment: implications for potential shortfalls in free antiretroviral therapy. PloS one. 2013; 8 (9): e70375.
[26]	Jimmy B, Jose J. Patient medication adherence: measures in daily practice. Oman medical journal. 2011; 26 (3): 155.
[27]	Dwajani S, Prabhu M, Ranjana G, Sahajananda H. Importance of medication adherence and factors affecting it. IP International Journal of Comprehensive and Advanced Pharmacology. 2020; 3 (2): 69-77.
[28]	Addo B, Sencherey S, Babayara MN. Medication noncompliance among patients with chronic diseases attending a primary health facility in a Periurban district in Ghana. International journal of chronic diseases. 2018; 2018.
[29]	Okoronkwo I, Okeke U, Chinweuba A, Iheanacho P. Nonadherence factors and sociodemographic characteristics of HIV-infected adults receiving antiretroviral therapy in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria. International Scholarly Research Notices. 2013; 2013.
[30]	Azia IN, Mukumbang FC, Van Wyk B. Barriers to adherence to antiretroviral treatment in a regional hospital in Vredenburg, Western Cape, South Africa. Southern African Journal of HIV Medicine. 2016; 17 (1).
[31]	Watt MH, Maman S, Earp JA, Eng E, Setel PW, Golin CE, et al. “It's all the time in my mind”: Facilitators of adherence to antiretroviral therapy in a Tanzanian setting. Social science & medicine. 2009; 68 (10): 1793-800.
[32]	Mills E, Cooper C, Seely D, Kanfer I. African herbal medicines in the treatment of HIV: Hypoxis and Sutherlandia. An overview of evidence and pharmacology. Nutrition journal. 2005; 4 (1): 1-6.
[33]	Babb D, Pemba L, Seatlanyane P, Charalambous S, Churchyard G, Grant A, editors. Use of traditional medicine in the era of antiretroviral therapy: experience from South Africa. Proceedings of the 15th International AIDS Conference; 2004.
[34]	Homsy J, King R, Balaba D, Kabatesi D. Traditional health practitioners are key to scaling up comprehensive care for HIV/AIDS in sub-Saharan Africa. Aids. 2004; 18 (12): 1723-5.
[35]	Endale Gurmu A, Teni FS, Tadesse WT. Pattern of traditional medicine utilization among HIV/AIDS patients on antiretroviral therapy at a university hospital in northwestern Ethiopia: a cross-sectional study. Evidence-based Complementary and Alternative Medicine. 2017; 2017.
[36]	Gall A, Shenkute Z, Kiefer D, Jackson J. Ethiopian traditional and herbal medications and their interactions with conventional drugs. Ethno Med. 2009; 1: 1-4.
[37]	Young S, Wheeler AC, McCoy SI, Weiser SD. A review of the role of food insecurity in adherence to care and treatment among adult and pediatric populations living with HIV and AIDS. AIDS and Behavior. 2014; 18 (5): 505-15.
[38]	Musumari PM, Wouters E, Kayembe PK, Nzita MK, Mbikayi SM, Suguimoto SP, et al. Food insecurity is associated with increased risk of non-adherence to antiretroviral therapy among HIV-infected adults in the Democratic Republic of Congo: a cross-sectional study. PloS one. 2014; 9 (1): e85327.
[39]	Olupot-Olupot P, Katawera A, Cooper C, Small W, Anema A, Mills E. Adherence to antiretroviral therapy among a conflict-affected population in Northeastern Uganda: a qualitative study. Aids. 2008; 22 (14): 1882-4.
[40]	Sanjobo N, Frich JC, Fretheim A. Barriers and facilitators to patients\'adherence to antiretroviral treatment in Zambia: a qualitative study. SAHARA-J: Journal of Social Aspects of HIV/AIDS. 2008; 5 (3): 136-43.
[41]	Nachega JB, Knowlton AR, Deluca A, Schoeman JH, Watkinson L, Efron A, et al. Treatment supporter to improve adherence to antiretroviral therapy in HIV-infected South African adults: a qualitative study. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2006; 43: S127-S33.
[42]	Weiser SD, Tuller DM, Frongillo EA, Senkungu J, Mukiibi N, Bangsberg DR. Food insecurity as a barrier to sustained antiretroviral therapy adherence in Uganda. PloS one. 2010; 5 (4): e10340.

Cite This Article

Plain Text BibTeX RIS

APA Style

Emmy Metta, William Yonathan, Melkizedeck Leshabari. (2021). “I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 7(1), 8-14. https://doi.org/10.11648/j.ijhpebs.20210701.12

Copy | Download

ACS Style

Emmy Metta; William Yonathan; Melkizedeck Leshabari. “I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2021, 7(1), 8-14. doi: 10.11648/j.ijhpebs.20210701.12

Copy | Download

AMA Style

Emmy Metta, William Yonathan, Melkizedeck Leshabari. “I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry. Int J HIV/AIDS Prev Educ Behav Sci. 2021;7(1):8-14. doi: 10.11648/j.ijhpebs.20210701.12

Copy | Download

@article{10.11648/j.ijhpebs.20210701.12,
  author = {Emmy Metta and William Yonathan and Melkizedeck Leshabari},
  title = {“I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry},
  journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
  volume = {7},
  number = {1},
  pages = {8-14},
  doi = {10.11648/j.ijhpebs.20210701.12},
  url = {https://doi.org/10.11648/j.ijhpebs.20210701.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20210701.12},
  abstract = {Background: Continuing use of ART treatments is reported to improve health and health outcomes of people living with HIV. However, adherence to ART prescriptions is generally a challenge and many people default from HIV care and treatment. This study assessed reasons for ART treatment default among adults living with HIV in Tunduru district Tanzania. Methods: We conducted a qualitative cross-sectional study between January and February 2018. Ten key informants who had defaulted from HIV care and treatment for five or more months were engaged in in-depth interviews on reasons behind defaulting. Thematic analysis using NVivo was conducted to identify emerging themes. Results: Reasons for defaulting from ART treatments which emerged include being tired of using the ART medications for a long time, not experiencing HIV related symptoms, fear of stigma and shame of being known to use ART, inadequate food, fear of side effects and use of local herbs as alternative. Other reasons include long distance to the health facilities and long waiting time for the services at the facility. Conclusion: Reasons for defaulting from HIV treatment and care among adults are multifaceted in nature requiring multifaceted efforts to address them if the gains intended from the use of ART are to be achieved and sustained.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - “I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry
AU  - Emmy Metta
AU  - William Yonathan
AU  - Melkizedeck Leshabari
Y1  - 2021/03/22
PY  - 2021
N1  - https://doi.org/10.11648/j.ijhpebs.20210701.12
DO  - 10.11648/j.ijhpebs.20210701.12
T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
SP  - 8
EP  - 14
PB  - Science Publishing Group
SN  - 2575-5765
UR  - https://doi.org/10.11648/j.ijhpebs.20210701.12
AB  - Background: Continuing use of ART treatments is reported to improve health and health outcomes of people living with HIV. However, adherence to ART prescriptions is generally a challenge and many people default from HIV care and treatment. This study assessed reasons for ART treatment default among adults living with HIV in Tunduru district Tanzania. Methods: We conducted a qualitative cross-sectional study between January and February 2018. Ten key informants who had defaulted from HIV care and treatment for five or more months were engaged in in-depth interviews on reasons behind defaulting. Thematic analysis using NVivo was conducted to identify emerging themes. Results: Reasons for defaulting from ART treatments which emerged include being tired of using the ART medications for a long time, not experiencing HIV related symptoms, fear of stigma and shame of being known to use ART, inadequate food, fear of side effects and use of local herbs as alternative. Other reasons include long distance to the health facilities and long waiting time for the services at the facility. Conclusion: Reasons for defaulting from HIV treatment and care among adults are multifaceted in nature requiring multifaceted efforts to address them if the gains intended from the use of ART are to be achieved and sustained.
VL  - 7
IS  - 1
ER  -

Copy | Download

Author Information

Emmy Metta

School of Public Health and Social Sciences, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
William Yonathan

School of Public Health and Social Sciences, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania
Melkizedeck Leshabari

School of Public Health and Social Sciences, Muhimbili University of Health and Allied Science, Dar es Salaam, Tanzania

Download PDF

Sections

Plain Text BibTeX RIS

APA Style

Emmy Metta, William Yonathan, Melkizedeck Leshabari. (2021). “I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry. International Journal of HIV/AIDS Prevention, Education and Behavioural Science, 7(1), 8-14. https://doi.org/10.11648/j.ijhpebs.20210701.12

Copy | Download

ACS Style

Emmy Metta; William Yonathan; Melkizedeck Leshabari. “I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry. Int. J. HIV/AIDS Prev. Educ. Behav. Sci. 2021, 7(1), 8-14. doi: 10.11648/j.ijhpebs.20210701.12

Copy | Download

AMA Style

Emmy Metta, William Yonathan, Melkizedeck Leshabari. “I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry. Int J HIV/AIDS Prev Educ Behav Sci. 2021;7(1):8-14. doi: 10.11648/j.ijhpebs.20210701.12

Copy | Download

@article{10.11648/j.ijhpebs.20210701.12,
  author = {Emmy Metta and William Yonathan and Melkizedeck Leshabari},
  title = {“I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry},
  journal = {International Journal of HIV/AIDS Prevention, Education and Behavioural Science},
  volume = {7},
  number = {1},
  pages = {8-14},
  doi = {10.11648/j.ijhpebs.20210701.12},
  url = {https://doi.org/10.11648/j.ijhpebs.20210701.12},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijhpebs.20210701.12},
  abstract = {Background: Continuing use of ART treatments is reported to improve health and health outcomes of people living with HIV. However, adherence to ART prescriptions is generally a challenge and many people default from HIV care and treatment. This study assessed reasons for ART treatment default among adults living with HIV in Tunduru district Tanzania. Methods: We conducted a qualitative cross-sectional study between January and February 2018. Ten key informants who had defaulted from HIV care and treatment for five or more months were engaged in in-depth interviews on reasons behind defaulting. Thematic analysis using NVivo was conducted to identify emerging themes. Results: Reasons for defaulting from ART treatments which emerged include being tired of using the ART medications for a long time, not experiencing HIV related symptoms, fear of stigma and shame of being known to use ART, inadequate food, fear of side effects and use of local herbs as alternative. Other reasons include long distance to the health facilities and long waiting time for the services at the facility. Conclusion: Reasons for defaulting from HIV treatment and care among adults are multifaceted in nature requiring multifaceted efforts to address them if the gains intended from the use of ART are to be achieved and sustained.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - “I Feel Healthy Like Any Other Person” Reasons for Defaulting from ART Treatments Use Among Adults Living with HIV in Tunduru District: A Qualitative Inquiry
AU  - Emmy Metta
AU  - William Yonathan
AU  - Melkizedeck Leshabari
Y1  - 2021/03/22
PY  - 2021
N1  - https://doi.org/10.11648/j.ijhpebs.20210701.12
DO  - 10.11648/j.ijhpebs.20210701.12
T2  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JF  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
JO  - International Journal of HIV/AIDS Prevention, Education and Behavioural Science
SP  - 8
EP  - 14
PB  - Science Publishing Group
SN  - 2575-5765
UR  - https://doi.org/10.11648/j.ijhpebs.20210701.12
AB  - Background: Continuing use of ART treatments is reported to improve health and health outcomes of people living with HIV. However, adherence to ART prescriptions is generally a challenge and many people default from HIV care and treatment. This study assessed reasons for ART treatment default among adults living with HIV in Tunduru district Tanzania. Methods: We conducted a qualitative cross-sectional study between January and February 2018. Ten key informants who had defaulted from HIV care and treatment for five or more months were engaged in in-depth interviews on reasons behind defaulting. Thematic analysis using NVivo was conducted to identify emerging themes. Results: Reasons for defaulting from ART treatments which emerged include being tired of using the ART medications for a long time, not experiencing HIV related symptoms, fear of stigma and shame of being known to use ART, inadequate food, fear of side effects and use of local herbs as alternative. Other reasons include long distance to the health facilities and long waiting time for the services at the facility. Conclusion: Reasons for defaulting from HIV treatment and care among adults are multifaceted in nature requiring multifaceted efforts to address them if the gains intended from the use of ART are to be achieved and sustained.
VL  - 7
IS  - 1
ER  -

Copy | Download