MPhil study projects

Factors influencing the low uptake of antiretroviral therapy among HIV positive adolescents in South Kgalagadi district, Botswana

Student: Weko Gomer Lulendo

Country: Botswana

The study was conducted in December 2019 at Tsabong Primary Hospital and Werda Clinic in Kgalagadi South district, Botswana. Its objective was to ascertain factors contributing to poor adherence to antiretroviral therapy (ART) among adolescents at these two facilities. Through semi-structured interviews, 48 adolescents were surveyed.

Adherence levels were assessed using a three-day recall method, yielding an adherence mean of 95,5%. Gender disparities were observed, with males averaging 94,4% adherence and females 96,2%. The study identified pill fatigue, stigma, adolescents’ daily activities and disclosure of HIV status by extended family members as significant contributors to poor adherence.

To address these issues, reinforcing adherence counselling and education during medical visits regarding the importance of ART, the risk of stigma and low self-esteem is crucial. Supporting visits should be increased and the use of reminders, such as alarms and phone calls, should be intensified, particularly for adolescents who experience adherence challenges.

Findings revealed that 15 SAM patients transitioned to the next rehabilitation phase in the MAM programme, while 13 MAM patients achieved successful recovery based on BMI assessment. Healthcare workers often deviated from rehabilitation guidelines due to shortages of essential nutritional commodities, forcing them to improvise with available resources.

Recommendations stressed the need for larger-scale nationwide studies. A dearth of literature on SAM and MAM management in HIV-positive populations is compounded by discrepancies between practices and national guidelines due to resource constraints. This disconnect underscores the potential for misleading results and highlights the need for improved resource allocation and adherence to established protocols.

Findings revealed that SMMEs generally offer employment conditions favourable for promoting treatment adherence among employees on chronic medication. Accessibility to treatment at health facilities and employees’ understanding of their medical conditions were noted as strengths. Formal workplace policies addressing basic conditions of employment, labour relations and HIV and tuberculosis wellness were however found to be inadequate. More than half of the respondents reported difficulties in adhering to medication schedules at work, pointing to challenges in taking medication at the correct time, skipping doses and experiencing medication-related work interference.