Abstract
Background: South Africa has the largest Human immunodeficiency virus (HIV) epidemic and
is operating the largest HIV treatment programme in the world with approximately 4.7 million
people on anti-retroviral treatment. South Africa has reached the testing targets or the first 95
of the UNAIDS 95-95-95 initiative. However, not all patients who tested positive for HIV are
initiated on ART (antiretroviral treatment) and not all those that initiated on ART treatment are
virally-suppressed and retained in care.
Aims: The purpose of the study was to determine and describe factors influencing the
initiation, retention, and adherence of PHC patients to ART medication and to make
recommendations for improving the initiation, adherence, and retention in the HIV care and
treatment programme.
Study design: A quantitative cross-sectional study design was used.
Methodology: A structured questionnaire method was used as a method of data collection
which was administered by the researcher. The questionnaire covered four sections. In section
A, the respondents were asked about their socio-demographics, in section B respondents
were asked about the treatment they were currently taking at the facility, section C covered
adherence based questions and section D covered retention-based questions. A nonprobability
convenience sampling technique was used to select the 377 study participants from
the clinic. Data was entered into MS Excel and cleaned. SPSS version 29 was used to conduct
the descriptive and inferential analyses. The chi-square test or equivalent was used to assess
the difference between participants that adhered and were retained on treatment and those
that were not adherent or retained on treatment. A stepwise logistic regression model with
Odds Ratios was conducted to determine factors associated with adherence and retention. A
p value of 0.05 was considered significant.
Results: There were 314 participants in the study with a response rate of 83%, the study
participants were predominantly female patients 206 (65.5%) as compared to male patients
105 (33.4%). Participants that were from urban area were 226 (72.0%) compared to those
from rural areas at 86 (27.4%). There were 53 (16.9%) participants in the age range of 18 to
34, in the age range of 35 to 54 there were 185 (58.9%) participants and the 55 above age
range had 75 (23.9%) participants. The total number of participants taking ART medication
was 310 (98.7%). Participants that were adherent to their medication was 300 (97.1%)
compared to 9 (2.9%) participants that were not adherent to their ART medication. Participants
that were retained in care were 246 (79.8%) compared to 62 (20.1%) of participants that were
not retained in care. The following factors were significantly associated with taking ART
iv
medication for > 12 months: age (>44 years; p value: 0.003), distance from the facility
(p=0.045). Results from the regression analyses indicated that factors significantly related to
adherence in care were: participants above 44 years of age had a higher likelihood of missing
an ART appointment date compared to those aged 44 years and below (OR = 1.97, 95% CI:
1.01-3.83, p = 0.046); participants who Missed 1-7 doses had a higher likelihood of missing
an ART appointment date compared to those who did not miss a dose (OR = 4.453, 95% CI:
2.38-9.75, p = 0.000); participants who had been attending the ART clinic for more than 12
months had a significantly lower likelihood of missing an ART appointment date compared to
those who had been attending for 12 months or less (OR = 0.19, 95% CI: 0.04-0.95, p = 0.043)
and factors significantly related to retention in care were: >12 months: age (>44 years,
p=0.034).
Conclusion: A significant number of participants were on ART medication. Most participants
in the study were already transitioned to Dolutegravir-based ART medication with only few
participants on Efavirenz-based regimens. Participants in the study revealed disparities
between males and females who are taking ART medication and retained in care. There are
more female participants that attended the clinic for collection of ART medication and retained
in care compared to male participants. Accessibility to the health facility is better in urban
areas as compared to rural areas. The ART clinic had fewer participants that recently started
ART medication as compared to the majority of the participants that were treatmentexperienced
patients. Marital status of participants contributed to the retention of participants
on ART medication. The missing of ART doses was an important predictor of poor adherence
in participants taking ART medications. Also, the longer the participant is retained in care was
related to good ART medication adherence. The results of the study will be used to provide
recommendations for development of strategies to improve initiation, adherence and retention
of patients at the PHC district hospital in Tshwane, South Africa.