Factors influencing adherence to antiretroviral therapy from the experience of people living with HIV and their healthcare providers in Sierra Leone: A qualitative study

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Abstract Background: Antiretroviral therapy is the main drug for the treatment of Human Immunodeficiency Virus, slow disease progression, and reduce the spread of infection. HIV treatment is also known to require high level of adherence of over 90% to achieve good treatment outcomes and viral load suppression. In Sierra Leone, it is estimated that about 70% of PLHIV are non-adherent in their first year of treatment. Understanding the reasons behind this high-rate of non-adherence is critical for the development of strategies to improve adherence. This study identifies the barriers and facilitators influencing adherence to antiretroviral treatment in Sierra Leone.Methods: A qualitative study design using in depth interviews was conducted in two districts in Sierra Leone – Freetown and Bo. In-depth interviews were conducted with 4 health care workers and 16 people living with HIV.Results: Several facilitators and barriers to Antiretroviral therapy(ART) adherence at the personal, community, and health system levels were identified. The facilitating factors included perceived benefits of ART, family support, having a treatment partner, receiving free ART medicines and belonging to peer support groups. The barriers included denial and non-disclosure of HIV status, frequency of medication, use of traditional medicine, lack of money for food and transport, stigma and discrimination, work barriers, lack of medicines and test kits, limited health workers and long distance to clinics. Conclusions: The key emerging themes arising from different health system level in this study include Support from families, treatment partners and the need for peer support groups. Understanding the facilitators and barriers to antiretroviral therapy identified in this study can improve adherence and provide relevant information for more responsive and equitable program implementation in low and middle-income countries. There is the need for implementing adherence augmentation programs with implementation of activities that will improve community knowledge for prevention and reduction of stigma and the need for integrating HIV treatment services close to communities.

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