Antiretroviral adherence in South Africa : are we burning our bridges?

Abstract

The national antiretroviral treatment programme in South Africa commenced in 2004 and today we have one of the largest antiretroviral programmes in the world. There is, however, growing concern about ARV adherence, the development of drug-resistant HIV and drug failure. Issues addressed are: treatment adherence following the national antiretroviral rollout in South Africa; and barriers to adherence. The general conclusion is that rates of ARV adherence in South Africa are probably similar to rates of adherence to treatments for other chronic diseases, namely between 40% and 50%. Various service-related, psychological, social and other barriers to adherence are discussed. Suggestions on how to assist ARV users to overcome adherence challenges and to reach the required adherence level of 90% or more are made. If we cannot achieve this, we might face a huge health crisis in future and are indeed burning one of our last bridges to stop the Aids epidemic.