Background: Antiretroviral therapy (ART) roll-out is fraught with challenges, many with serious repercussions. We\r\nexplored and described patient behaviour-related challenges from the perspective of health care providers from\r\nnon-governmental organisations involved in ART programmes in KwaZulu-Natal, South Africa.\r\nMethods: A descriptive case study design using qualitative approach was applied during this study. Data was\r\ncollected from nine key informants from the three biggest NGOs involved in ART roll-out using in-depth semistructured\r\ninterviews. Transcribing and coding for emergent themes was done by two independent reviewers.\r\nEthical approval for the study was granted by the UNISA research ethics committee of The Faculty of Health\r\nSciences. Written consent was obtained from directors of the three NGOs involved and individual audio taped\r\ninformed consent was obtained from all study participants prior to data collection.\r\nResults: Findings revealed six broad areas of patient behaviour challenges. These were patient behaviour related to\r\nsocio-economic situation of patient (skipping of medication due to lack of food, or due to lack of transport fees),\r\nbelief systems (traditional and religious), stigma (non- disclosure), sexual practices (non-acceptability of condoms,\r\nteenage pregnancies), escapism (drug and alcohol abuse) and opportunism (skipping medication in order to access\r\ndisability grant, teenage pregnancies in order to access child grant).\r\nConclusion: New programmes need to address patient behaviour as a complex phenomenon requiring a multipronged\r\napproach that also addresses social norms and institutions. In the face of continued ART scale up, this is\r\nfurther evidence for the need for multi-sectoral collaboration to ensure successful and sustainable ART roll-out.
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