The role of treatment buddies in the public-sector antiretroviral programme in the Free State Province
Hlophe, Hlengiwe Isabel
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Recent advances in antiretroviral treatments have simplified dosing regimens for people living with HIV. Yet, typical regimens still remain far more complex than treatments for other health conditions and adherence continue to concern health care providers. Adherence to antiretroviral therapy still dominates debates as one of the challenges facing HIV positive patients and the health service delivery. Thus, support for people on antiretroviral therapy becomes fundamental. It sis therefore argued that treatment buddies can be critical element in enhancing adherence and in retaining patients in care Against this background, research was undertaken to assess the role of treatment buddies in the South African public sector antiretroviral treatment programme as implemented in the Free State province. To achieve this aim certain objectives and hypothesis were identified and based on these objectives, five key outcomes for the study were identified. This study used two sources of data: (i) data collected from a longitudinal study conducted among patients enrolled in the public sector antiretroviral treatment programme (patient survey) and (ii) data from once-off individual interviews conducted with treatment buddies of patients interviewed as part of the patient survey (treatment buddy survey). Patients included in the analysis represent the sub-sample of patient respondents in the survey observed at least once in each of the four phases of the treatment career (n=160). Following the completion of the sixth and final round of the patient interviews, telephonic interviews were conducted with treatment buddies (n=55) using a semi-structured interview schedule to supplement information on treatment buddies collected in the patient survey as well as to provide insight into some findings from the patient survey data. Analyses for the purposes of this study focused on an investigation of treatment support and related outcomes over the treatment career. Various bivariate and multivariate regression analyses were performed separately for point estimates and change outcomes for each of the five main outcomes. Differences and transitions in key explanatory variables were regressed on point estimates of the main outcomes, while point estimates and lagged differences or transitions in key explanatory variables were regressed on differences and transitions in main outcomes respectively to avoid problems of endogeneity and to focus on causal dynamics of cause-and -effect. The study reveals that throughout the study, access to a treatment buddy declined over the treatment duration. As expected, health related quality of life consistently impacted on access to and transitions in access to a treatment buddy. Patients who had access to a treatment buddy had improved health-related quality of life. The treatment career phase featured as a strong predictor of access to a treatment buddy. Access to treatment buddy declined as months on treatment increased. The study reveals that similar to access to a treatment buddy, access to alternative support mechanisms declined as treatment duration increased. However, a significant decline over the treatment career phase was only observed in access to informal, individualised support such as emotional and physical caregivers. Access to more formal support and to group-based support did not exhibit a similar significant declining trend over the treatment career. The findings revealed that access to a treatment buddy was associated with perfect adherence knowledge. Moreover, the frequency of treatment buddy visits declined over the treatment career. Access to other forms of support increased the frequency of treatment buddy visits. Marital status was strongly associated with access to treatment buddy and other key outcomes. Clinical adherence varied significantly across the treatment career, increasing as treatment duration increased. The transition results indicate that patients who had been on treatment for six to twelve months and patients who had been on treatment for 18 to 30 months were less likely to transition from clinical adherence to non-adherence. This statement denotes that patients who have been on treatment for a longer period are more likely to maintain clinical adherence. Overall, the research indicates that treatment buddies represent an important form of informal adherence and psycho-social support in the early phase of the ARV treatment career, particularly among married ART clients. Access to treatment buddies declines later in the treatment career as clients‟ health-related quality of life improves. Policy makers and programme managers should develop suitable adherence support strategies for single clients as well as suitable longer-term adherence support strategies for clients facing challenges with medication adherence later in the treatment career.