Objective. Measuring adherence levels and assessing the impact on adherence to ART (antiretroviral treatment) of the factors: disclosure to partner, partner support, other support and length of time between diagnosis and ART commencement, in a state-run ART clinic at Mitchells Plain Community Health centre. Design. A retrospective case control study was conducted and the information was obtained by means of a file audit. Methods. Every 5th file was selected for the study and 199 participants were chosen based on the inclusion and exclusion criteria. Adherence for each patient was measured using a formula documented in a published study. For the comparison group 82 cases (non-adherent patients) were matched for age and gender with 82 adherent controls. Results. The mean adherence for the initial group of 199 participants was 80.1%. Disclosure to a partner and partner support were not found to significantly affect adherence. The time between HIV diagnosis and ART commencement was also not found to make a statistically significant difference to adherence. There appeared to be an association, though not statistically significant, between other support (not from the partner) and >95% adherence (p= 0.0579). Conclusion. It can be concluded that adherence is probably influenced by a wide variety of factors. More qualitative studies or larger samples are recommended to better assess the impact of partner support and acceptance of HIV on adherence. Approaches to partner disclosure prior to commencing ART should be reviewed. The mean adherence level of 80.1% is an indication that more work is urgently needed to improve adherence levels in state-run clinics in South Africa.

HIV and AIDS pandemic have been declining in South Africa. HIV and AIDS affect individuals, families, organizations and the communities at large. While the roll out of the antiretroviral treatment (ART) has brought much excitement and hope to both patients and the health practitioners, it has also brought challenges (Maskew, Macphail, Menez & Rubel, 2007:853). In order for ART to be effective patients need to adhere to antiretroviral treatment, thus adherence is a critical component of ART. Patients who discontinue treatment are at high risk of illness and death because of AIDS related diseases or developing drug resistant virus. With a better understanding of the reasons for defaulting antiretroviral treatment interventions can be designed to improve adherence to antiretroviral treatment. Thus the purpose of this study was to explore the reasons why HIV and AIDS infected patients default antiretroviral treatment because adherence to ART is of utmost important. Within the context of qualitative and applied research the researcher utilized the collective case study design. Semi structured interviewing was used as data collection method to elicit qualitative information on the reasons why patients default ART. The main research question that was put forward to all participants was: What are your reasons for defaulting ART? The participants in this study were patients who have default their ART during 2012. By using systematic sampling fourteen participants from Thekganang ARV Clinic in Seshego District Hospital, Limpopo province, were selected to form a sample for this study. Some conclusions based on the findings were that: The participants were knowledgeable about the basic facts of HIV and AIDS and they had a good understanding about the importance of adherence even though they defaulted their antiretroviral treatment. The use of ART may also be challenging to individuals. The findings of this study were that not all participants in the study experienced challenges with taking ART. Those who experienced challenges included fear of disclosing HIV status, fear of stigmatization and physical challenges due to ill health. Regarding the reasons for defaulting ART, participants’ reasons for defaulting antiretroviral treatment were similar although some of the reasons applied to only one participant. Participants’ reasons for treatment default were classified into socio-economic factors, patient related, psychological related and medication related factors. Socio- economic factors included shortage of food in the household and lack of money for transport to attend clinic appointments. Patient related factors included substance abuse, lost appointment cards, participants were too busy with personal issues and relocation to another area of residence. Psychological factors that contributed to non-adherence to treatment were depression and denial. Medical related factor voiced was that participant was too confused about the drug regimen. Most participants were satisfied with the services in Thekganang ARV clinic although some participants raised concerns about staff attitudes and long queue. The findings will assist the hospital management and the clinic staff to make informed decisions about the management of defaulters in the clinic. The study was concluded with the relevant recommendations to the ART facilities. The recommendations included implementation of the multi-disciplinary centred approach, establishing patient education programmes and on-going support services to patients who fail to adhere to treatment. Future research studies should determine the prevalence of drug resistant HIV patients in the ART facilities and the development of a systematic method of capturing ‘‘lost to follow up’’ patients who pass away within hospitals. / Dissertation (MA)--University of Pretoria, 2014. / lk2014 / Social Work and Criminology / MA / Unrestricted