Scaling-Up of Antiretroviral Therapy: A Contribution to Analysis of Factors that Influence Adherence to Treatment in Zambia

Introduction: The purpose of this study is to analyse factors that influence optimal adherence to Antiretroviral treatment (ART) as poor adherence results in drug resistance and has a high potential of minimising results of ART scaling-up efforts in Zambia. In addition, current adherence enhancing interventions related to the identified factors are also reviewed.

Methods: Literature review was conducted on studies examining factors that influence adherence to treatment that are known internationally and in Zambia and interventions that have been internationally studied to enhance adherence. The electronic search engine used was Google. Electronic databases and websites where searched for relevant information. The study was based on the question: What factors influence adherence to ART? To analyse the problem of poor adherence to treatment, the PRSP and Anderson 3-factor models where adapted to develop a conceptual framework.

Findings: Factors that are negatively related to treatment adherence include factors related to individuals such as forgetting, being too busy, low level of academic education, poor disease and treatment literacy, poor income, depression, excessive alcohol intake, initiation of ART in the asymptomatic stage, medication side effects, pill burden, poor patient-provider relationship, stigma and lack of social support. Positive correlates of adherence include having reminders to deal with cognitive factors such as forgetting, tailoring medication intake to one’s daily routine; high level of education, disease and treatment literacy, timely management of disorders such as depression, intensive treatment preparation, continuous adherence education and psychosocial counseling, uninterrupted supply of drugs, simplifying treatment regimen, and availability of support groups. Age and gender are seen to have weak correlations.

Conclusion : Many studies have focused on correlates of adherence which are related to individuals on treatment and those related to medication. Health care delivery system factors, community factors, factors related to the way various providers interact and political factors have been overlooked. Zambia is currently experiencing problems related to all adherence factors identified in this study and there is need that these are efficiently dealt with. There is need for research in the factors that have received limited attention. Additionally, adherence enhancing interventions done in other countries can be adapted in Zambia by creation of enabling environments and adequate support to PLWHA. Creation of such environment will also facilitate broadening the inclusion criteria in people’s eligibility for ART.