Personal barriers to antiretroviral therapy adherence: case studies from a rural Uganda prospective clinical cohort

Background: Although good adherence to antiretroviral therapy (ART) is essential for successful treatment outcomes,some patients may have specific personal barriers to ART adherence.
Objectives: To study specific personal barriers to ART adherence.
Methods: Quantitative data on patients’ health status, ART adherence, CD4 cell counts and viral loads were collected, and qualitative data on life experiences of five patients with poor ART outcomes and adherence were also collected.
Results: Out of 35 patients with poor immunological and virological ART outcomes, 17 (49%) also had poor ART adherence. Patient 1 had no living child and did not disclose her HIV serostatus to her spouse because she wanted to have a child. Patient 2 was an orphan with neither social nor family support. Patient 3 stopped ART when she conceived, returned to the study clinic when pregnant again and was sickly. She was switched to second-line ART with satisfactory outcomes. Patient 4, a 14 year old orphan had missed ART for 2 months when his treatment supporter was away. Patient 5 aged 66 years stopped ART which he blamed for his erectile dysfunction.
Conclusions: ART adherence counselling should target specific personal barriers to ART adherence like: lack of family support, health and sexual life concerns, desire to have children and family instability.

Keywords
Personal barriers; ART adherence; stigma; disclosure; children desire; sexual dysfunction