Abstract #309  -  Nurses perspectives on Botswana patients anti-retroviral therapy adherence
Authors:   Presenting Author:   Dr Esther Kip - Ministry of health
Additional Authors:  Prof Valerie  Ehlers, Dr Dirk van der Wal,
Aim: The purpose of this exploratory, descriptive, qualitative study was to determine nurses perspectives on Botswana patients anti-retroviral therapy (ART) adherence, and to identify factors which could promote or hinder ART adherence.
Method / Issue: This was a qualitative study. Four ART sites were randomly selected. A non-probability purposeful sampling method was used to select 16 nurses providing ART services at these sites. Semi-structured interview guide with open-ended questions was utilized for data collection. Data were analyzed using Techs open coding method. Permission was sought from the Health Research Unit at the Ministry of Health and the health care facilities in the districts.
Results / Comments: The participants indicated that patients ART adherence was influenced by service-related and patient-related factors. Service-related factors included the inaccessibility of ART clinics, limited clinic hours, health workers� inability to communicate in patients� local languages, long waiting times at clinics and delays in getting informed about their CD4 and viral load results. Nurses could not trace defaulters nor contact them by cell-phones. Nurses had to work night shifts, disrupting nurse-patient relationships. Patient-related factors included patients lack of education, inability to understand the significance of CD4 and viral load results, financial hardships, non-disclosure and non-acceptance of their HIV positive status, alcohol abuse, the utilisation of traditional medicines and side effects of ART.
Discussion: The government of Botswana has achieved a lot in prolonging the lives of HIV infected individuals; however, there are still some challenges in the provision of ART. This study made a decided contribution towards an understanding of the ART patients� and nurses� situations in trying to manage ART. It has shown that decidedly more is needed than free ART and a limited number of nurses without telephone access, and without transport to reach defaulting patients, to institute and maintain sufficiently high levels of ART adherence among patients. The challenges of lifelong ART adherence are multifaceted involving both patient-related and service-related factors. Adherence to ART along with patients� lifestyle adjustments is the key in decreasing viral loads, increasing CD4 counts and preventing multidrug-resistant HIV strains from widespread transmission, which will aggravate the HIV/AIDS pandemic. Patients� adherence can be improved when health care providers give clear explanations, support, encouragement, hope and conduct follow-up visits to defaulters� homes. Health care providers should provide concise communication to the patients about the purpose of their therapy, impart necessary instructions on the proper use of the prescribed medications as well as what to expect while taking medications in order to enhance patients� adherence.
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