Background: Namibia is one of the countries in the world most affected by HIV/AIDS with
the national prevalence of 18.8% in 2010. In 2010, it was reported that an estimated 180,000
Namibians were living with HIV/AIDS; of which 95,000 adult women, 69,000 adult men and
16,000 children. An estimated 6,700 deaths was recorded in 2009 with an estimated number
of 70,000 orphans due to the disease.
The introduction of anti-retroviral therapy (ART) in public health facilities in Namibia in
2003 has improved the quality of lives of patients with advanced HIV disease, prolonged
their lives and enabled them to be economically productive. By 2010 about 90,000 patients
were enrolled on ART program in all 34 district hospitals and 3 intermediate referrer
hospitals. Adherence to antiretroviral therapy is a key attribute of clinical HIV care and the
overall determining factor in gauging the effectiveness of treatment. Good adherence to ART
is vital to sustain low viral loads and prevent the development of drug resistant HIV strains.
Although the patient retention rate on ART at the Katima Mulilo Hospital was 98.3%, with
increased patient uptake to the program in future, there is a need to be aware of factors that
influence adherence to ART as such findings could inform the expanded ART program in
Caprivi region.
Methodology: An explorative, qualitative study was conducted where in-depth interviews
were conducted with 24 ART patients and key informants interviews with 2 health workers.
Data were audiotape recorded and transcribed verbatim. Thematic and content analysis of
transcribed data was performed.
Results: The study found that facilitators to adherence included self-motivation and
determination to succeed in the program, the desire to live and take care of loved ones, and
having social support from family, friends, and health workers. The barriers to adherence
included negative perceptions about the effectiveness of ART, confinement into prison, HIV
related-stigma and discrimination by the community and the use of traditional healers. Socioeconomic
factors such as poverty and alcohol, lack of means of livelihood, unemployment
and the burden of taking care of many orphans by themselves had negative influences on
adherence. The health system factors such as long distance to health facility to access ART
medications, congestions in the clinics and shortage of manpower were identified as barriers
to good ART adherence.
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Recommendations: There is a need to bring ART services closer to the people to shorten the
long distances that must be travelled to access ART services. The need to intensify outreach
services to patients in their communities will prevent defaulting from ART program and
improve better access to ART. There is a need for the expansion of the existing infrastructure
to reduce congestion in Katima Mulilo Hospital ART clinic to prevent the agony patients
currently experienced. The employment of more staff to complement the existing staff will
promote ART adherence among the patients. The improvement of the socio-economic status
of ART patients needs to be addressed through job creation, provision of grants and food
rations to reduce dependence on family and friends.