HIV-treatment adherence: Exploring experiences of peer counsellors and young-adult clients in HIV Care centres in Eswatini

Abstract

Achieving viral load suppression is a persistent challenge amongst young people in HIV care in Southern Africa, Eswatini in particular. Research has shown that treatment-adherence counselling has been central in the global response to HIV and is tipped as central in adherence support to increase treatment efficacy as well as help prevent drug resistance. The Ministry of Health introduced a National Expert Client programme in 2007 to shift tasks including Pre-ART counselling and preparation for ART for newly identified clients. Since then, the scope of expert clients has expanded to include ongoing counselling for clients in care to enhance adherence to care and treatment. This study aimed at exploring experiences of peer-counsellors and young-adult clients on HIV-treatment adherence counselling in one HIV care centre in Eswatini. Data were collected over a period of 3 months and involved 6 peer counsellors who worked in the facility for at least 6 months, and 12 young-adult clients (15-24 years of age) who had at least 6 months in HIV care and treatment. This study used a combination of in-depth interviews and observation methodological approaches. Collected data was transcribed, translated and analysed using systematic text condensation. The main findings of the study include how participants viewed living with HIV as burden; How dedicated social support played a role in treatment support and adherence as well as stigma both experienced and anticipated. From these, we discussed two dimensions of burden that generally were expressed from the findings which included living with HIV and the need to take ART daily to achieve optimum health. The findings also demonstrated that stigma remains a huge threat to access and actual retention in adherence, care and treatment for clients and counsellors alike in the facility and community. Young-adults accessing care did not feel as part of the decision-making process about their care but instead were dictated to and had to conform to healthcare workers' orders. These combined determined if the client would achieve adherence to care and treatment notwithstanding the prescribed standard counselling that was given.