Communication Factors Influencing Antiretroviral Therapy Non-Adherence Among Test And Start Clients In Zomba District, Malawi

Abstract

Malawi adopted test-and-start approach for initiating HIV diagnosed clients on antiretroviral therapy (ART) in HIV management in 2016. Despite notable improvements in ART coverage, adherence still remains suboptimal. A cross sectional convergent parallel mixed methods study was conducted amongst 325 test and start clients and 68 health workers and expert clients in Zomba District, to assess communication factors contributing to non- adherence. Quantitative data were collected using a structured questionnaire. Qualitative data was collected using topic guides for FGDs, KIIs and IDIs. Logistic regression was used in quantitative data analysis to test associations. Thematic analysis was used to analyse qualitative data. Despite lack of quantitative evidence that communication factors influence adherence, qualitative results showed that they in fact do. The following intra-personal factors had potential to influence nonadherence: lack of knowledge about test and start, hearing about test and start for first time at hospital, health feeling, denial and negative attitude towards test and start. Interpersonal communication factors such as disclosure, poor quality counselling, not freely talking about ART had potential to influence non-adherence. Only one factor, follow up calls by health worker, was significantly associated with adherence (OR=1.787, 95% C.I:1.410-2.513). Social cultural factors such as poverty and prolonged time spent at health facility potentially influence non-adherence. Long distance to health facility did not influence non-adherence but rather encouraged privacy of clients. Communication about test-and-start should begin at community level. For effective adherence, other media of communication such as radio, television and posters, should also be emphasized in communicating ART test and start messages. Health workers should ensure that clients are well educated on the importance of test and start prior to ART initiation. A system to follow up ART clients with missed scheduled appointments should be strengthened to enhance adherence.