Patients' adherence to anti-retroviral therapy in Botswana

To identify factors influencing patients' anti-retroviral therapy (ART) adherence at four clinics in Botswana.

Quantitative descriptive. Structured interviews were conducted with a random sample of 400 patients out of the population of all patients attending the four randomly selected ART clinics in Botswana during April and May 2007.

Data were analysed using SPSS version 13. Chi-square and p-value calculations were done to test significance of the relationships between categories or variables.

Patient-centred barriers to ART adherence included inadequate knowledge about ART, human immunodeficiency virus (HIV), acquired immunodeficiency syndrome (AIDS), CD4 cell and viral-load results, stigma, travelling costs, waiting times at clinics, side effects of ART, use of traditional (indigenous or folk) medicines, and abuse of alcohol. Service-centred barriers included nurses' attitudes and knowledge, health workers' inability to conduct home visits and to contact defaulters, limited clinic hours, delays in getting CD4 and viral-load results.

ART adherence requires more than free ART. Adherence levels will improve if both patient-centred and service-centred barriers are addressed.

Nurses play key roles in educating patients about ART adherence and side effects, but they should also educate patients about CD4 and viral-load test results and about the dangers of using traditional medicines and alcohol with ART. Shorter waiting times at clinics could make ART patients' lives more manageable.