Abstract
In addition to personal and psychological factors, structural factors may reduce the likelihood of optimal adherence to antiretroviral therapy (ART) among persons living with HIV. In this mixed-method study we report on the development of a scale to assess the salience of various structural barriers to ART adherence. After following conventional guidelines for scale development, two scales measuring structural barriers to adherence to clinic attendance and pill-taking were administered to 291 patients receiving ART at a public hospital in South Africa. Both exploratory and higher order factor analysis indicated that a single underlying general factor was appropriate for both scales. The final scales consisted of 12 items for the structural barriers to clinic attendance scale and 13 items for the structural barriers to medication-taking scale. Both scales displayed excellent internal consistency with Cronbach alpha coefficients above 0.80. Research to determine the construct validity of the scales may be a next step in this line of research.
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References
Joint United Nations Programme on HIV/AIDS. Global Report: UNAIDS report on the global AIDS epidemic. 2010.
Nischal KC, Khopkar U, Saple DG. Improving adherence to antiretroviral therapy. Indian J Dermatol Venereol Leprol. 2005;71(5):316–20.
Mills EJ, Nachega JB, Buchan I, Orbinski J, Attaran A, Singh S, et al. Adherence to antiretroviral therapy in sub-Saharan Africa and North America: a meta-analysis. JAMA. 2006;296(6):679–90.
Sledjeski EM, Delahanty DL, Bogart LM. Incidence and impact of posttraumatic stress disorder and comorbid depression on adherence to HAART and CD4+ counts in people living with HIV. AIDS Patient Care STDS. 2005;19(11):728–36.
Kalichman SC, Rompa D, DiFonzo K, Simpson D, Austin J, Luke W, et al. HIV treatment adherence in women living with HIV/AIDS: research based on the information–motivation–behavioral skills model of health behavior. J Assoc Nurses AIDS Care. 2001;12(4):58–67.
Kalichman SC, Ramachandran B, Catz S. Adherence to combination antiretroviral therapies in HIV patients of low health literacy. J Gen Intern Med. 1999;14(5):267–73.
Weiser S, Wolfe W, Bangsberg D, Thior I, Gilbert P, Makhema J, et al. Barriers to antiretroviral adherence for patients living with HIV infection and AIDS in Botswana. J Acquir Immune Defic Syndr. 2003;34(3):281–8.
Gordillo V, del Amo J, Soriano V, Gonzalez-Lahoz J. Sociodemographic and psychological variables influencing adherence to antiretroviral therapy. AIDS. 1999;13(13):1763–9.
Berg CJ, Michelson SE, Safren SA. Behavioral aspects of HIV care: adherence, depression, substance use, and HIV-transmission behaviors. Infect Dis Clin North Am 2007; 21(1):181–200, x.
Ware NC, Wyatt MA, Tugenberg T. Social relationships, stigma and adherence to antiretroviral therapy for HIV/AIDS. AIDS Care. 2006;18(8):904–10.
Shriver MD, Everett C, Morin SF. Structural interventions to encourage primary HIV prevention among people living with HIV. AIDS. 2000;14(Suppl 1):S57–62.
Kagee A, Remien RH, Berkman A, Hoffman S, Campos L, Swartz L. Structural barriers to ART adherence in Southern Africa: challenges and potential ways forward. Glob Public Health. 2011;6(1):83–97.
Coetzee B, Kagee A, Vermeulen N. Structural barriers to adherence to antiretroviral therapy in a resource-constrained setting: the perspectives of health care providers. AIDS Care. 2011;23(2):146–51.
Kagee A, Delport T. Barriers to adherence to antiretroviral treatment: the perspectives of patient advocates. J Health Psychol. 2010;15(7):1001–11.
Hardon AP, Akurut D, Comoro C, Ekezie C, Irunde HF, Gerrits T, et al. Hunger, waiting time and transport costs: time to confront challenges to ART adherence in Africa. AIDS Care. 2007;19(5):658–65.
Dahab M, Charalambous S, Hamilton R, Fielding K, Kielmann K, Churchyard GJ, et al. “That is why I stopped the ART”: patients’ & providers’ perspectives on barriers to and enablers of HIV treatment adherence in a South African workplace programme. BMC Public Health. 2008;18(8):63.
Roura M, Busza J, Wringe A, Mbata D, Urassa M, Zaba B. Barriers to sustaining antiretroviral treatment in Kisesa, Tanzania: a follow-up study to understand attrition from the antiretroviral program. AIDS Patient Care STDS. 2009;23(3):203–10.
Swartz L, Dick J. Managing chronic diseases in less developed countries. BMJ. 2002;325(7370):914–5.
Cole FL, Abel C. Climate of care and nurses’ attitudes towards AIDS in the emergency department. Emerg Nurse. 2000;8(4):18–24.
Gueritault-Chalvin V, Kalichman SC, Demi A, Peterson JL. Work-related stress and occupational burnout in AIDS caregivers: test of a coping model with nurses providing AIDS care. AIDS Care. 2000;12(2):149–61.
Murray LK, Semrau K, McCurley E, Thea DM, Scott N, Mwiya M, et al. Barriers to acceptance and adherence of antiretroviral therapy in urban Zambian women: a qualitative study. AIDS Care. 2009;21(1):78–86.
Smit R. HIV/AIDS and the workplace: perceptions of nurses in a public hospital in South Africa. J Adv Nurs. 2005;51(1):22–9.
Maskew M, MacPhail P, Menezes C, Rubel D. Lost to follow up: contributing factors and challenges in South African patients on antiretroviral therapy. S Afr Med J. 2007;97(9):853–7.
Posse M, Meheus F, van Asten H, van der Ven A, Baltussen R. Barriers to access to antiretroviral treatment in developing countries: a review. Trop Med Int Health. 2008;13(7):904–13.
Tuller DM, Bangsberg DR, Senkungu J, Ware NC, Emenyonu N, Weiser SD. Transportation costs impede sustained adherence and access to HAART in a clinic population in southwestern Uganda: a qualitative study. AIDS Behav. 2010;14(4):778–84.
Nachega JB, Knowlton AR, Deluca A, Schoeman JH, Watkinson L, Efron A, et al. Treatment supporter to improve adherence to antiretroviral therapy in HIV-infected South African adults. A qualitative study. J Acquir Immune Defic Syndr. 2006;43(Suppl 1):S127–33.
Weiser SD, Tuller DM, Frongillo EA, Senkungu J, Mukiibi N, Bangsberg DR. Food insecurity as a barrier to sustained antiretroviral therapy adherence in Uganda. PLoS ONE. 2010;5(4):e10340.
Brown L, Macintyre K, Trujillo L. Interventions to reduce HIV/AIDS stigma: what have we learned? AIDS Educ Prev. 2003;15(1):49–69.
Derlega VJ, Winstead BA, Greene K, Serovich J, Elwood WN. Perceived HIV-related stigma and HIV disclosure to relationship partners after finding out about the seropositive diagnosis. J Health Psychol. 2002;7(4):415–32.
Nothling J. Strukturele hindernisse tot ART volhoubaarheidheid onder MIV positiewe pasiënte. Unpublished Masters Thesis, Stellenbosch University; 2009.
De Vellis RF (1991) Scale development: theory and applications. Applied Social Research Methods Series. Newbury Park: SAGE.
Bolton P, Wietse A, Tol JB. Introduction to special issue: combining qualitative and quantitative research methods to support psycho social and mental health programmes. Intervention. 2009;7(3):181–6.
Stevens J. Applied multivariate statistics for the social sciences. 2nd ed. Hillsdale: Erlbaum; 1992.
Schmid J, Leiman JM. The development of hierarchical factor solutions. Psychometrika. 1957;22:53–61.
De Bruin D. The dimensionality of the general work scale. A hierarchical exploratory factor analysis. SA J Ind Psychol. 2006;32(4):68–75.
Field AP. Discovering statistics using SPSS: (and sex, drugs and rock’n’roll). 2nd ed. London: SAGE; 2005.
Kaiser HF. An index of factorial simplicity. Psychometrika. 1974;39:31–6.
Miles KK, Clutterbuck DJ, Seitio OO, Sebego MM, Riley AA. Antiretroviral treatment roll-out in a resource-constrained setting: capitalizing on nursing resources in Botswana. Bull World Health Organ. 2007;85(7):555–60.
Jaffar S, Govender T, Garrib A, Welz T, Grosskurth H, Smith PG, et al. Antiretroviral treatment in resource-poor settings: public health research priorities. Trop Med Int Health. 2005;10(4):295–9.
Falagas ME, Zarkadoulia EA, Pliatsika PA, Panos G. Socioeconomic status (SES) as a determinant of adherence to treatment in HIV infected patients: a systematic review of the literature. Retrovirology. 2008;1(5):13.
Nguyen VK, Ako CY, Niamba P, Sylla A, Tiendrebeogo I. Adherence as therapeutic citizenship: impact of the history of access to antiretroviral drugs on adherence to treatment. AIDS. 2007;21(Suppl 5):S31–5.
Rintamaki LS, Davis TC, Skripkauskas S, Bennett CL, Wolf MS. Social stigma concerns and HIV medication adherence. AIDS Patient Care STDS. 2006;20(5):359–68.
Duff P, Kipp W, Wild TC, et al. Barriers to accessing highly active antiretroviral therapy by HIV-positive women attending an antenatal clinic in a regional hospital in western Uganda. J Int AIDS Soc. 2010;13:37.
Johnson LF. Access to antiretroviral treatment in South Africa, 2004–2011. S Afr J HIV Med. 2012;13(1):22–7.
Dorrington RE, Johnson LF, Bradshaw D, Daniel T. The demographic impact of HIV/AIDS in South Africa. National and Provincial indicators for 2006. Cape Town: Centre for Actuarial Research, South African Medical Research Council and Actuarial Society of South Africa; 2006.
Remien RH, Hirky AE, Johnson MO, Weinhardt LS, Whittier D, Le GM. Adherence to medication treatment: a qualitative study of facilitators and barriers among a diverse sample of HIV + men and women in four US cities. AIDS Behav. 2003;7(1):61–72.
Tomlinson M, Rohleder P, Swartz L, Drimie S, Kagee A. Broadening psychology’s contribution to addressing issues of HIV/AIDS, poverty and nutrition: structural issues as constraints and opportunities. J Health Psychol. 2010;15(7):972–81.
Ivers LC, Chang Y, Gregory Jerome J, Freedberg KA. Food assistance is associated with improved body mass index, food security and attendance at clinic in an HIV program in central Haiti: a prospective observational cohort study. AIDS Res Ther. 2010;26(7):33.
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Coetzee, B., Kagee, A. The Development of an Inventory to Assess the Structural Barriers to Clinic Attendance and Pill-taking Amongst Users of Antiretroviral Therapy. AIDS Behav 17, 319–328 (2013). https://doi.org/10.1007/s10461-012-0374-z
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DOI: https://doi.org/10.1007/s10461-012-0374-z