Providing anti-retroviral therapy in the context of self-perceived stigma: a mixed methods study from Tanzania
TARIMO, EDITH A.M & GEORGE, JOHN
Adherence to anti-retroviral treatment (ART) has been a significant step towards improving
quality of life among people living with HIV. However, stigma has been described to influence adherence
to ART. A cross-sectional mixed methods study was conducted to explore factors related to stigma and
perceived influence of stigma on adherence to treatment amongst ART-prescribed patients and health
care providers, respectively in Tanzania. Stigma was assessed through interviewer administered survey
among 295 patients. The results from patients showed that 279/295 (95%) were satisfied with the services
provided at the Care and Treatment Centres (CTCs). The set up of CTCs 107/295 (36%), and queuing at the
CTCs 88/295 (30%) were associated with stigma (P<0.001). The perceived influence of stigma on
adherence to ART was assessed using focus group discussions (FGDs) of 33 health care providers (HCPs).
Through FGDs, HCPs perceived the set up of CTCs as friendly yet violated confidentiality. The HCPs
reported that ART-prescribed patients hide identifiable cards to avoid being recognised by other people.
Some patients were reported to rush to avoid familiar faces, and due to the rush they picked wrong
medicines. Also some patients were reported to throw away manufacturers’ box with dosage
instructions written on the box, resulting in use of doses contrary to the prescriptions. We conclude that
despite the fact that most patients were satisfied with the services provided at the CTCs, it is important
that HCPs provide dosage instructions on another piece of paper or use disposable bags. A common
dispensing window for all patients regardless of the diagnosis may be useful to minimize stigma. Also
HCPs may introduce appointment system to avoid long queue at the CTCs.
Stigma; adherence; HIV/AIDS; ART; Tanzania