Grant: Travel Awards - Institute Community Support

In the wake of the optimism around antiretroviral therapy (ART) as prevention, addressing the barriers to long-term ART adherence is critical. This is particularly important given the tendency to individualize or use a blame discourse to ascertain why HIV positive patients "fail" to adequately adhere to ART. Reasons for disengaging from ART care are also not often adequately explored within specific contexts despite there being diverse contextual reasons for poor adherence that may require varying solutions. This study documents the factors that challenge ART adherence in one community, as well as context appropriate solutions. This study took place at 3 clinics and 1 hospital in Khayelitsha, Cape Town, South Africa, a community with an antenatal HIV seroprevalence > 30%. Interviews were conducted with 27 HIV positive patients who had defaulted on ART and were admitted to Khayelitsha Hospital for clinical complications, as well as 9 ART service providers including doctors, nurses and HIV counselors. Interviews assessed reasons why patients defaulted on ART with the consequence of requiring hospitalization and explored ways in which this could be prevented. Data from both groups were analyzed collectively using thematic analysis. In light of the findings, recommendations to address contextual barriers to long-term ART adherence are offered including those at a health systems level and those that require bridging support. The study points to the need to know your context related to ART adherence challenges, including those faced by specific sub-groups, to direct your response.