Barriers and facilitators of ART adherence in Hawassa town, Southern Ethiopia: A grounded theory approach

Background: Antiretroviral therapy (ART) has the potential to significantly reduce the risk of HIV transmission and the spread of tuberculosis and improve quality of life. Patient's adherence is crucial to get the best out of ART. As ART is scaled up in Ethiopia, there is a need for better understanding of the factors that influence patients' adherence to ART and improve the service. This study aims to explore patients' and health care professionals' views about factors that facilitate and hinder adherence to ART among adult HIV patients. Methods: A qualitative grounded theory study using non-participant observation; and in-depth interview with 23 ART users and 5 health professionals were carried out at two health facilities that serve a large number of HIV-positive individuals in Hawassa town, Southern Ethiopia. The study was conducted from February to April 2014. Simultaneous data collection and analysis was conducted and taped Notes were transcribed into Amharic then translated into English. The grounded theory approach was used for analyzing the data. The analysis began by using the constant comparison approach. The coding process was preceded by open coding, axial and selective coding. To manage the overall coding process, Atlas. ti (v.7) software was used. Results: The commonest barriers to adherence-included poverty, substance misuse, forgetfulness and being busy, fear of stigma and discrimination, pill burden and medication side effects. The most frequently emerged facilitators to adherence included disclosure of HIV status, using an adherence aid, prospects of living longer, social support, experiencing better health and trusting health workers. Conclusion: The study revealed a range of barriers to adherence including individual, medical, environmental and economic related factors. The findings from our study can be used to inform the development of effective interventions that address the barriers and facilitators of ART adherence in Ethiopia. Priority should be given to improving adherence by alleviating financial constraints to ART adherence, better access to treatment services, education and counseling to tackle culture related obstacles, stigma and discrimination.