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Cited by 10HIV/AIDS Research and InterventionsHIV, Drug Use, Sexual RiskHIV/AIDS drug development and treatment

‘We have goals but [it is difficult]’. Barriers to antiretroviral therapy adherence among women using alcohol and other drugs living with HIV in South Africa

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Ndirangu, Jacqueline W., Gichane, Margaret W., Browne, Felicia A., Bonner, Courtney P., Zule, William A., Cox, Erin N., Smith, Kevin M., Carney, Tara +1 more·2022·Health Expectations
DOI 10.1111/hex.13422PMC PMC8957738
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Abstract

Background: Women living with HIV who misuse alcohol and live in economically disadvantaged settings in South Africa experience a multitude of contextual barriers as they navigate the HIV care continuum. The Women's Health CoOp (WHC), a brief, woman‐focused, behavioural, evidence‐based intervention, has been shown to be effective in reducing heavy drinking and improving HIV‐related outcomes among this key population. However, these women face other broader socioecological barriers to antiretroviral therapy (ART) adherence. Methods: The WHC was implemented in a modified, stepped‐wedge implementation science trial in public health clinics and substance use treatment programmes in Cape Town, South Africa. A qualitative substudy was conducted to explore barriers to HIV treatment adherence among women enrolled in this trial. Eight focus group discussions were conducted with 69 participants 6 months after completion of the WHC workshops. Focus groups were audio‐recorded (with consent), transcribed verbatim and analysed using a thematic approach. Results: The mean age of the participants was 33 years and the mean self‐reported number of drinks per day was 13. The main contextual factors influencing participants’ ART adherence were intrapersonal‐level factors (substance use, financial constraints, food insecurity; community‐level factors (anticipated and enacted stigma, community violence) and institutional‐level factors (patient–provider relationships, health facility barriers, environmental stigma). Conclusion: Comprehensive interventions addressing the contextual barriers and unique challenges faced by women who misuse alcohol in low‐resource settings that intersect with HIV treatment nonadherence should be implemented in tandem with successful biobehavioural HIV interventions for long‐term effectiveness and sustainability. Patient or Public Contribution: Our South African community collaborative board has been involved throughout this study; participants and clinic staff voices have been essential in our interpretation of these findings.

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Authors
Ndirangu, J. W., Gichane, M. W., Browne, F. A., Bonner, C. P., Zule, W. A., Cox, E. N., Smith, K. M., Carney, T., & Wechsberg, W. M.
Affiliations
  • RTI International (US)
  • University of North Carolina at Chapel Hill (US)
  • South African Medical Research Council (ZA)
Corresponding author
Ndirangu, Jacqueline W.
ORCID
Venue
Health Expectations
Publisher
Wiley
Published
2022-01-21
Volume
25
Issue
2
Pages
754-763
ISSN
  • 1369-6513 (ISSN-L)
  • 1369-7625
DOI
10.1111/hex.13422
PMC
PMC8957738
OpenAlex
W4206735946
Cited by
10
References
8
Citations by year
2026: 2 · 2025: 1 · 2024: 2 · 2023: 3 · 2022: 2
FWCI
0.98
Type
journal article
Language
en
Open access
Licence
Locations
  • Health Expectations (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
National Institute on Alcohol Abuse and Alcoholism (R01AA022882)
Topics
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
  • Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
  • Health Sciences › Medicine › Infectious Diseases › HIV/AIDS drug development and treatment
Keywords
antiretroviral therapy adherence, HIV, women, alcohol abuse, substance use, contextual barriers, stigma, community violence, financial constraints, food insecurity, patient-provider relationship, resource-limited settings, South Africa
MeSH terms
Adult, Female, Goals, Humans, Patient Compliance, South Africa, HIV Infections, Anti-Retroviral Agents

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