The salience of structural barriers and behavioral health problems to ART adherence in people receiving HIV primary care in South Africa

AIDS Care. 2024 Jul;36(sup1):154-160. doi: 10.1080/09540121.2024.2308750. Epub 2024 Feb 15.

Abstract

Multilevel factors (individual and structural) influence adherence to antiretroviral therapy, particularly in high HIV prevalence areas such as South Africa. The present study examined the relative importance of structural barriers to HIV care and behavioral health factors, depression and alcohol use, in Khayelitsha, Cape Town, South Africa. People receiving HIV care in six primary care clinics in Khayelitsha (N = 194) completed the Center for Epidemiologic Studies Depression Scale, the Alcohol Use Disorders Identification Test, the Structural Barriers to Medication Taking questionnaire, and a qualitative rating of past-two-week adherence. Correlations were employed to examine associations among these variables, and hierarchical regression analysis was used to examine the unique effects of structural barriers over and above depression and alcohol use as predictors of adherence. Participants were primarily Black South African (99%) women (83%), and 41 years old on average. All four variables were significantly correlated. The hierarchical regression analysis showed that among behavioral health predictors, alcohol use alone significantly predicted ART adherence (b = -.032, p = .002). When structural barriers was added to the model, it was the only significant unique predictor of ART adherence (b = -1.58, p < .001). Findings highlight the need to consider structural vulnerabilities in HIV care in South Africa when developing behavioral health interventions.

Keywords: ART adherence; HIV; SDG 10: Reduced inequalities; SDG 3: Good health and well-being; alcohol use; depression; structural barriers.

MeSH terms

  • Adult
  • Alcohol Drinking / epidemiology
  • Alcohol Drinking / psychology
  • Anti-HIV Agents / therapeutic use
  • Depression* / epidemiology
  • Depression* / psychology
  • Female
  • HIV Infections* / drug therapy
  • HIV Infections* / psychology
  • Health Services Accessibility
  • Humans
  • Male
  • Medication Adherence* / psychology
  • Medication Adherence* / statistics & numerical data
  • Middle Aged
  • Primary Health Care*
  • South Africa / epidemiology
  • Surveys and Questionnaires

Substances

  • Anti-HIV Agents