Original Research

Adherence to antiretroviral treatment by adults in a rural area of Botswana

Valerie J. Ehlers, Emmanuel T. Tshisuyi
Curationis | Vol 38, No 1 | a1255 | DOI: https://doi.org/10.4102/curationis.v38i1.1255 | © 2015 Valerie J. Ehlers, Emmanuel T. Tshisuyi | This work is licensed under CC Attribution 4.0
Submitted: 05 November 2013 | Published: 29 May 2015

About the author(s)

Valerie J. Ehlers, Department of Health Studies, University of South Africa, South Africa
Emmanuel T. Tshisuyi, Department of Health Studies, University of South Africa, South Africa

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Background: As antiretroviral therapy (ART) is becoming increasingly available to people in developing countries, ART adherence challenges assume ever greater significance. Often underlying treatment failure is the fact that suboptimal adherence to ART is the strongest predictor of failure to achieve viral suppression below the level of detection.

Objectives: The study’s main objective was to identify factors affecting ART adherence levels, as well as the impact on immunologic and virologic responses in adult patients in one rural district in Botswana.

Methods: A cross-sectional quantitative survey, was used. Structured interviews were conducted with 300 ART patients between November 2011 and February 2012. Data were analysed, then presented in charts, graphs and frequency tables.

Results: The prevalence of non-adherence to ART was 14.0%. Motivators of good adherence included disclosure of HIV-positive status to more than one person, frequent adherence counselling, self-efficacy for adherence to ART, positive interactions between patients and healthcare providers; and using adherence partners. Barriers to adherence were forgetfulness, transportation costs to and from the clinic, time away from work and side-effects. There was a strong positive correlation between adherence, CD4 counts and viral load. Adherence was closely tied to immunologic and virologic improvements. Respondents with poor adherence were likely to have unsuppressed viral loads (OR 12.98, 95% CI 4.9–34).

Conclusion: Adherence to ART is closely tied to virologic, immunologic, and clinical outcomes. Increases in adherence levels resulted in significant improvements in these outcomes. Near perfect adherence, however, is required to maximise the likelihood of long-term clinical success, which could pose challenges to many ART patients, especially in resource-limitedrural settings.


Adherence to anti-retroviral therapy (ART), ART in Botswana, CD4 cell counts, HIV/AIDS, viral load


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