As South Africa aims to dramatically increase the number of its HIV-infected citizens on antiretroviral therapy (ART), leaders there know they will be creating a new challenge: Getting people to stay on their treatment.
Treatment is crucial to reducing the spread of HIV, since those who are able to reduce the amount of HIV in the body (viral load) to where it is undetectable are no longer able to transmit it to someone else. Failure to stay on treatment can also lead to drug resistance. Yet there are many barriers both to initiating treatment and adhering to it, from concerns about stigma to the challenges of taking a pill every day to the costs of getting to the clinic to pick up treatment.
To this end, USAID in South Africa asked the Johns Hopkins Center for Communication Programs’ Breakthrough ACTION project to help understand how to improve adherence to HIV medications among those who were struggling the most. Breakthrough ACTION recently shared its recommendations designed to help people to stay on treatment and re-engage with care if they have struggled to stay adherent.
“South Africa has excellent treatment guidelines for people who have defaulted on their treatment, though some patients continue to struggle,” says CCP’s Beth Mallalieu, who co-led the effort. “We want to help officials there to take what they have in place and strengthen it to help even more people benefit.”
To come up with the recommendations, Breakthrough ACTION reviewed South Africa’s national ART adherence guidelines, analyzed programmatic information and used human-centered design to generate insights about how people might better be supported to stay engaged in care, remain on treatment and become virally suppressed.
Breakthrough ACTION found that intensive counseling, for example, should be provided at the outset of treatment to make sure a clear understanding of the benefits of adhering to treatment are in place from the start. Further, providers may need improved training to better understand the challenges of adherence that patients might face, while explaining both the dangers of defaulting and the implications of not taking ART consistently.
Another recommendation is that patients learn and understand their viral load at each appointment so they are aware of how the treatment is working. “By monitoring their own progress,” the report states, “patients may find motivation along the way.”
Recommendations also include increasing the use of peer navigators, those with HIV who have successfully stayed on treatment, to help those newly diagnosed or those who have struggled to with treatment.
Mallalieu says she hopes the results of this work will help tackle disengagement from care and improve adherence and clinical outcomes.
“We need to find a way to make it easier for those who are struggling to access counseling and medication,” she says. But she concedes it’s not a one-size-fits-all solution.
“Everyone’s reasons for not taking their medication is different,” she says. “It’s very personal. And we need to recognize that and find a path that helps people get where they need to be.”