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Influences on Adherence to Antiretroviral Therapy (ART) in Early-Stage HIV Disease: Qualitative Study from Uganda and South Africa

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Abstract

Realization of optimal treatment and prevention benefits in the era of universal antiretroviral therapy (ART) and “U=U” (undetectable = untransmittable) requires high adherence at all stages of HIV disease. This article draws upon qualitative interview data to characterize two types of influences on ART adherence for 100 Ugandans and South Africans initiating ART during early-stage HIV infection. Positive influences are: (a) behavioral strategies supporting adherence; (b) preserving health through adherence; (c) support from others; and (d) motivating effect of adherence monitoring. “De-stabilizing experiences” (mobility, loss, pregnancy) as barriers are posited to impact adherence indirectly through intervening consequences (e.g. exacerbation of poverty). Positive influences overlap substantially with adherence facilitators described for later-stage adherers in previous research. Adherence support strategies and interventions effective for persons initiating ART later in HIV disease are likely also to be helpful to individuals beginning treatment immediately upon confirmation of infection. De-stabilizing experiences merit additional investigation across varying populations.

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Acknowledgements

The authors gratefully acknowledge the contributions of qualitative participants, and the research assistants who collected the qualitative data: Catherine Kyampire, Regina Panda, and Khosi Tshangela. We thank the META Study team: Principal Investigators: Dr. Jessica E. Haberer, Dr. Catherine Orrell, Dr. Norma C. Ware, Dr. Mwebesa Bosco Bwana, Dr. Stephen Asiimwe, Dr. Gideon Amanyire, Hon. Dr. Elioda Tumwesigye, Dr. David R. Bangsberg. Co-Investigators: Dr. Alex Tsai, Dr. Mark Siedner, Dr. Lynn Matthews, Dr. Ingrid Katz, Monique Wyatt. Program Managers: Annet Kembabazi, Stephen Mugisha, Victoria Nanfuka, Anna Cross, Nicky Kelly, Daphne Moralie, Kate Bell. Statistician: Nicholas Musinguzi. Data Managers: Dolphina Cogill, Justus Ashaba, Zoleka Xapa, Mathias Orimwesiga, Elly Tuhanamagyezi, Catherine Kyampaire. Lab Managers: Don Bosco Mpanga, Leonia Kyarisima, Simone Kigozi. Research Assistants: Nomakhaya April (RN), Alienah Mpahleni, Vivie Situlo, Speech Mzamo, Nomsa Ngwenya, Khosi Tshangela, Regina Panda, Teboho Linda, Christine Atwiine, Sheila Moonlight, Edna Tindimwebwa, Nicholas Mugisha, Peace Atwogeire, Dr. Vian Namana, Catherine Kyampaire, Gabriel Nuwagaba. Drivers: Edgar October, Silver Mugisha, Ibrahim Kiviiri.

Funding

This study was funded by the Bill and Melinda Gates Foundation (OPP1056051).

Author information

Authors and Affiliations

  1. Deparment of Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Norma C. Ware

  2. Deparment of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Ave., Boston, MA, 02115, USA

    Norma C. Ware, Monique A. Wyatt, Emily E. Pisarski & Jessica E. Haberer

  3. Harvard Global, Cambridge, MA, USA

    Monique A. Wyatt

  4. Mbarara University of Science and Technology, Mbarara, Uganda

    Bosco M. Bwana

  5. Global Health Collaborative, Mbarara, Uganda

    Bosco M. Bwana, Stephen Asiimwe, Gideon Amanyire & Nicholas Musinguzi

  6. Desmond Tutu HIV Foundation, Cape Town, South Africa

    Catherine Orrell

  7. University of Cape Town, Cape Town, South Africa

    Catherine Orrell

  8. Kabwohe Clinical Research Centre, Kabwohe, Uganda

    Stephen Asiimwe

  9. Makerere University Joint AIDS Program, Kampala, Uganda

    Gideon Amanyire

  10. Oregon Health and Science University–Portland State University School of Public Health, Portland, OR, USA

    David R. Bangsberg

  11. Massachusetts General Hospital Center for Global Health, Boston, MA, USA

    Jessica E. Haberer

Authors
  1. Norma C. Ware
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  2. Monique A. Wyatt
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  3. Emily E. Pisarski
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  4. Bosco M. Bwana
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  5. Catherine Orrell
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  6. Stephen Asiimwe
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  7. Gideon Amanyire
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  8. Nicholas Musinguzi
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  9. David R. Bangsberg
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  10. Jessica E. Haberer
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Consortia

the META Study Team

Contributions

NCW and MAW designed the qualitative study. MAW and EEP oversaw collection of the qualitative data. NCW and EEP analyzed the qualitative data. NM contributed quantitative data on personal characteristics of participants in the qualitative study, compared to META study participants. NCW wrote the first draft and subsequent revisions of the manuscript, with input from MAW, EEP, and JEH. All authors critically reviewed and approved the final version.

Corresponding author

Correspondence to Norma C. Ware.

Ethics declarations

Research Involving Human and Animal Participants

All procedures performed in studies involving human participants were in accordance with the ethical standards of: (1) Partners Healthcare/Massachusetts General Hospital, Boston, MA, USA; (2) Harvard Medical School, Boston, MA, USA; (3) Mbarara University of Science and Technology, Mbarara, Uganda; (4) the Uganda National Council for Science and Technology, Kampala, Uganda; (5) University of Cape Town, Cape Town, South Africa; and (5) Western Cape province, South Africa, and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Ware, N.C., Wyatt, M.A., Pisarski, E.E. et al. Influences on Adherence to Antiretroviral Therapy (ART) in Early-Stage HIV Disease: Qualitative Study from Uganda and South Africa. AIDS Behav 24, 2624–2636 (2020). https://doi.org/10.1007/s10461-020-02819-z

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  • DOI: https://doi.org/10.1007/s10461-020-02819-z

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