Examining Geographic and Social Barriers to HIV Treatment Adherence in Kampala, Uganda
Abstract
With the rapid expansion of HIV treatment programs across sub-Saharan Africa, substantial progress has been made towards universal treatment accessibility in Uganda; however, new healthcare challenges have been emerging, such as the development of drug-resistant HIV, which threaten to undermine achievements made thus far. In order for HIV treatment to be effective, people living with HIV (PLWH) must be highly adherent without missing a single dose, which can be challenging for those also facing difficulties such as financial insecurity. In the context of Kampala, Uganda’s urban capital, it has been suggested that healthcare accessibility is made difficult by several physical and social barriers. However, knowledge of the extent to which such barriers, especially geographical barriers might influence HIV treatment success is lacking. This is a mixed methods study which examines geographical barriers to adherence within the socio-economic context of Kampala. Using data from a survey administered to individuals on treatment at the Joint Clinical Research Center (JCRC) in Kampala (n=149), the study employs logistic regression to examine the association between geographical barriers and treatment outcomes. Semi-structured interviews (n=30) were also conducted to deepen our understanding of lived experiences with HIV treatment. Results were unexpected, suggesting that participants living more than two hours away from the treatment facility were actually less likely to miss their daily dose of medication (OR = 0.33, p < 0.05), compared to those living in proximity to the treatment center. Findings from the interviews helped to explain these paradoxical findings, as it was reported that PLWH prefer clinics further from their home to avoid being recognized. The effect of HIV stigma was reported to further impact adherence at home and in workspaces, as PLWH felt pressured to take medication in secrecy. The results of our regression suggested that high-income employment (OR = 3.82, p < 0.05) and partnered relationship status (OR = 4.28, p < 0.05) were predicted to increase the probability of missing doses. Challenges to HIV treatment adherence such as stigmatization and transportation costs must therefore be considered in conjunction with one another, as determinants of health are overlapping and inextricable.