Factors that promote adherence among clients receiving free antiretroviral therapy in Northern Tanzania

Background: Studies show that adherence to antiretroviral therapy (ART) is relatively high in African settings, but few have explored factors that facilitate adherence. Qualitative research can help explain the context that supports adherence, leading to lessons for interventions.

Methods: We conducted individual semi-structured interviews with 36 patients receiving free ART at one clinic in Arusha, Tanzania. The sample was selected for representation by gender and time on ART. Swahili-speaking interviewers asked patients to describe how ART fits into their daily routine, strategies used to adhere, barriers faced in adhering, and self-reported adherence over the past month. The interviews were audio-recorded, transcribed, translated and coded with Atlas t.i.

Results: Of 36 respondents (mean time on ART 9.8 months; range 1-24), 32 reported perfect adherence in the previous month. Five factors emerged to explain excellent adherence. First, all were seriously sick before starting ART and pointed to the drugs as restoring their health. Second, respondents were motivated to stay healthy to meet family responsibilities. Third, respondents routinized pill-taking by linking it with daily activities or events. Fourth, respondents received tangible and emotional support from family members that facilitated adherence. Fifth, respondents expressed trust in the advice and instructions of their health care providers.

Conclusions: Most patients in this setting reported perfect adherence, although findings are limited by possible self-reporting bias. Interventions to sustain or enhance adherence in Tanzania may seek to bolster psychological motivators, link regimens to daily routines, and improve social support, all factors that facilitated ART adherence in this sample.