Predictors of Treatment Adherence and Virological Failure Among People Living with HIV Receiving Antiretroviral Therapy in a South African Rural Community: A Sub-study of the ITREMA Randomised Clinical Trial

A large proportion of people living with HIV (PLHIV) in sub-Saharan Africa reside in rural areas. Knowledge of enablers and barriers of adherence to antiretroviral treatment (ART) in these populations is limited. We conducted a cohort study of 501 adult PLHIV on ART at a rural South African treatment facility as a sub-study of a clinical trial (ClinicalTrials.gov NCT03357588). Socio-economic, psychosocial and behavioral characteristics were assessed as covariates of self-reported adherence difficulties, suboptimal pill count adherence and virological failure during 96 weeks of follow-up. Male gender was an independent risk factor for all outcomes. Food insecurity was associated with virological failure in males. Depressive symptoms were independently associated with virological failure in both males and females. Household income and task-oriented coping score were protective against suboptimal pill-count adherence. These results underscore the impact of low household income, food insecurity and depression on outcomes of ART in rural settings and confirm other previously described risk factors. Recognition of these factors and targeted adherence support strategies may improve patient health and treatment outcomes.

Support services available for elderly women caring for people living with HIV and AIDS in Masindi District, Uganda

In sub-Saharan Africa, HIV/AIDS remains a big challenge and a leading cause of death among young adults, its main productive human resource. Hence, increasing the demand for care and support services by the epidemic infected and affected people. As a result, elderly persons, especially women are burdened to provide care and support; a midst disintegrated family support system and the inability of public and private sectors to adequately address their needs. The current qualitative study examined the support services available for elderly women caring for people living with HIV/AIDS in Masindi district, Uganda. A purposive sampling method was used to recruit 24 participants. In-depth interviews were conducted with 18 elderly women caregivers and 6 key informants. Findings indicated that the elderly women caregivers were at least receiving support from two major sectors; including the informal (family, friends, neighbors, religious and community groups) and formal (The Aids Support Organisation- TASO and the government) support systems. However, this support was not consistent and efficient for optimal caregiving. Therefore, more needs to done by making both the informal and formal support systems fully available for elderly caregivers for HIV/AIDS people, thus, benefiting from direct intervention and support services to help meet their care needs.

Experiences of elderly women caring for people living with HIV and AIDS in Masindi District, Uganda

HIV/AIDS prevalence among adults aged 15-49 is increasingly affecting elderly women as caregivers. This study explored the experiences of elderly women caring for people living with HIV/AIDS in Masindi District, Uganda. Employing qualitative methods, 24 participants (18 elderly women caregivers and 6 key informants) were purposively selected. Data was collected from in-depth face-to-face interviews and analysed thematically. Findings revealed that participants performed numerous roles, resulting in economic, psychological, social and physical challenges. Coping strategies employed are problem and emotion-focused. Elderly women caring for HIV/AIDS persons will benefit from direct intervention and support services.

Culture, role conflict and caregiver stress: The lived experiences of family cancer caregivers in Nairobi

This article explores the experiences of a small group of Nairobi women caring for a family cancer patient at home. On the basis of literature on women as caregivers in Africa, and on other literature more broadly, it was anticipated that issues around generational roles, gender and women's cultural role would be relevant. Seven women participated in semi-structured in-depth interviews, while thirteen women participated in four mini focus groups. Data were analysed using interpretative phenomenological analysis. Findings underscore the socio-cultural complexities of caregiving as a basis for evidence-based culturally appropriate structures to support family caregivers.

Family cancer caregiving in urban Africa: interrogating the Kenyan model

This article interrogates the complexities of the family cancer caregiver role in an urban (Nairobi) context within the framework of the model of palliative care in sub-Saharan Africa. Individual interviews and focus groups were utilized to explore the phenomenon of family cancer caregiving. Data were analysed from an interpretative phenomenological approach. Emergent themes demonstrate the ambiguities inherent in the cultural context of cosmopolitan Nairobi where, in addition to their traditional designated roles, women caregivers simultaneously took on non-traditional roles including single-parenting and full-time professions. Findings point to the need for a more nuanced understanding of the complexities of family cancer caregiving, a process which inevitably entails interrogating assumptions about the ‘African’ and, more specifically, the ‘Kenyan’ model of caring.