The results are discussed in this section. Twelve12 participants took part in the study. Majority of participants were treatment-experienced patients. No gender was dominant in this study. The age of 30–39 years was the dominated age group among participants.
i. Table 1 below describes the demographic characteristics of the participants.
Characteristics | N = 12 |
Gender | Females = 6 Males = 6 |
Age | 18–29 = 1 30–39 = 6 40–45 = 4 |
Marital status | Single = 8 Married = 2 Not married but staying with partner = 2 |
Level of Education | No schooling = 0 Primary school = 2 Secondary school = 3 Matric = 7 Tertiary = 0 |
Employment | Employed = 7 Unemployed = 5 Pensioner = 0 |
The table below gives a description of the themes and sub themes that emerged through participants’ responses on their perceptions regarding the use of DTG based regimen.
ii. Table 2: A summary of the themes and sub themes
Themes | Sub themes |
1. Acceptance of new treatment, dolutegravir | 1.1. Benefits of new treatment, dolutegravir 1.2. persistent adherence to new treatment |
2. Level of knowledge regarding the new treatment dolutegravir | 2.1. insight to importance of taking new treatment 2.2. Lack of Knowledge regarding the new treatment |
3. The burden of taking ART treatment | 3.1. Side effects to previous regimen 3.2. side effects to DTG based regimen |
4. Reasons of Non adherence to dolutegravir | 4.1. Alcohol use and work related issues |
The following themes and related sub-themes were identified in the study 1) acceptance of new treatment, Level of knowledge regarding the new treatment dolutegravir, the burden of taking ART treatment and reasons to Non adherence to dolutegravir.
Theme 1: Acceptance of new treatment
Acceptance of the new treatment, dolutegravir emerged as the first theme and benefits of new treatment and persistent adherence to new treatment dolutegravir were identified as the sub-themes.
Sub-theme 1.1: Benefits of new treatment, dolutegravir
The following reflections from the majority of participants indicated that the new treatment known as dolutegravir had acceptable benefits and that their lives had changed as they felt better. A common view was that the new treatment did not inflict any problems in their lives. It was also indicated that dolutegravir enhanced strength and energy and appetite stimulation. These were expressed as follows:
Uhmm, according to me, the medication treats me good and does not give me problems, it is just okay. I’m not sure if it’s because I am used to them or what, but according to me, they are very good to me. No, this medication is good, that’s why I said they started treating me good from the beginning. When they changed me to these ones, I thought I would experience side effects like my previous treatment until I get used to them but when I took them at night, I did not have any problem. The following day again I did not have any problem then I figured these ones are better than my previous ones.(PA).
Another participant voiced:
I never had any problem from the word go with this treatment until now; even my child was born fine. My child was born HIV negative. I think it’s because of the treatment and taking it correctly. My wife is also HIV positive but we live normally. The thing is we were told at the clinic that if we take our treatment well, we will give birth to an HIV negative child. So we did that because we wanted our child to be clean.” (PG)
One statement from a participant indicated that dolutegravir enhanced them with strength and appetite.
Aaah, Isn’t it the body also changes and have some strength, I am no longer weak and have power. Meaning that medication that I am taking now, at least it gives me strength and does its job well in my body. (PA)
A quote from another participant emphasizing that the new treatment enhances strength and appetite was as follows:
I mean I never had any side effects that they said I will have or maybe make me sick. They said sometimes the pills can make you sick at the beginning of your treatment, but I never experienced any of those things. According to me, I see a change that is good since I started taking the treatment… I see myself having more energy and eating more, so I assume that it’s the new pills that do that to me. (PK)
Another participant also supported the sentiment by saying:
Eish, they are fine. When I take them every day my body becomes fine. I eat a lot sometimes, like, I can do many things. (Pause)… maybe I can jog a bit for a distance and have strength. I also gained weight, that’s how I see the treatment is good. (PE)
Sub-theme 1.2: persistent adherence to new treatment
The findings revealed that participants showed persistent adherence to new treatment, and it was echoed that one main reason for that was due to the treatment being well tolerable.
One participant stated:
You have to take them and not skip days because the more you skip, the more the virus has power and… what is it again? Your immune system starts to decrease. So, you have to take them every day and should take your treatment accordingly. I take mine every day at 8 at night and the fact that the treatment does not give me problems, makes it easy for me to take it(PE)
Another participant indicated:
What I can say is that, for the treatment to work effectively, you need to take it accordingly and don’t skip your treatment. If you don’t do so, you won’t see its effectiveness. What is important is to listen to the instructions said at the clinic. When they say take your treatment in the morning or at night, do as you are told and then you will be fine. You need to do something that will make you remember time to take your treatment. It’s a good thing the treatment is fine in my body so I have no reason not to take it, and I make sure to take mine at 7 O’clock every night.(PL)
Majority of the participants showed great acceptance of the new treatment, dolutegravir and acknowledged the benefits that the treatment had in their lives. Adherence to new treatment was also an indication of acceptance of the treatment as it was showed to be tolerable by most patients.
Theme 2: Level of knowledge regarding the new treatment (dolutegravir)
The level of knowledge regarding new treatment, dolutegravir emerged as the second theme and addressed three sub themes namely, insight to importance of taking new treatment dolutegravir and Lack of Knowledge regarding the new treatment
Sub-theme 2.1: Insight to importance of taking new treatment.
In most cases, participants reported being aware of the importance of taking their treatment effectively to ensure that HI virus is controlled.
One interviewee indicated:
Eeeh, I don’t know how to explain it. Let me say, when you take treatment, at first it will try to adjust with your body to kill the virus that is in your body, but it does not mean that you are cured when you drink them, they just manage the disease by making the virus dizzy. But if you take your medication properly, it means that these pills can kill this disease and you can be cured.(PB)
Another participant argued:
You have to take them and not skip days because the more you skip, it’s the more the virus has power and… what is it again? Your immune system starts to decrease. So, you have to take them every day and should take your treatment accordingly. I take mine every day at 8 at night and the fact that the treatment does not give me problems, makes it easy for me to take it. (PE)
To support the sentiment of being aware of the importance of taking treatment, one participant indicated that:
The new treatment should be taken every day so that the HIV disease can be managed and not make you sick, then you will live normally. But if you don’t take it accordingly you will get sick and everyone will see that you are sick and now then you won’t be able hide the fact that you are sick. Taking treatment gives you a chance to live like any normal person and work any kind of job you want just like other people. (PL)
Sub-theme 2.2: Lack of knowledge regarding the new treatment (dolutegravir)
Majority of participants showed lack of knowledge about the new treatment. Furthermore, it was evident that they were somewhat not aware that their previous regimen was changed to the new regimen. This was expressed as follows:
One participant said:
Aii, I’m not sure…(laughs). They give us different containers every time, so I’m not too sure if it’s still the same treatment or not. The inside is the same; it’s just that the package is different so I’m not sure what that means… they tend to change the bottles. Today you get a blue bottle, next month it’s a white bottle then the other month you can get a blue one again. (PK)
Another participant voiced:
I don’t have much perception about my treatment. What I know is that you must take your course accordingly…I mean you should take treatment the way you were told by the nurses. You should not skip taking your medication and adhere to your dates for collection of treatment. Now I feel like I am fine, I am 100 percent fine… Yes, they changed mine but I did not ask why they changed them. In my mind I thought it’s just stages. You either have completed the first stage and you are now in the second stage. (PI)
Another participant echoed the same sentiment:
(Silence)… What I know about this treatment… I don’t have anything I know, I just take the treatment with the perception that since I was sick and not knowing who I was, they said I must take the treatment every day and that was it. (PJ)
One participant said:
I just know that the treatment is to heal us, and we should take them every time and that if you take them correctly you won’t have a problem, you will be able to live like any normal person.(PG)
Overall, participants seemed to have knowledge about the importance of taking treatment, but the actual insight to the new treatment dolutegravir was deficient in majority of them.
Theme 3: The burden of taking the previous regimen
The findings showed that majority of participants started their HIV treatment journey with a different ART regimen and were switched to DTG based regimen. A few participants had DTG based regimen as their first and only regimen. A theme named the burden of taking ART treatment emerged with its subthemes namely, side effects to previous regimen and side effects to DTG based regimen
Sub-theme 3.1: Side effects to previous regimen
Majority of participants interviewed were experienced HIV Positive patients who started their HIV treatment journey on a different ART regimen then were switched to DTG based regimen. While comparing the new treatment to their previous regimen, a common concern expressed was having experienced unpleasant side effects to their previous regimen which made it difficult for them to tolerate the treatment. This sentiment was echoed by participants in the following quotes:
One participant stated that:
At the beginning when I was drinking the HIV treatment I was taking before the new ones, they treated me somehow. I wondered if I should stop taking them or go to the clinic and report. At night when I was asleep, I would feel dizzy while in bed, I would dream of weird things. I would dream of people who died. I would just see scary things, as if I am falling underneath the bed. So, as I was explaining to them, they told me that these pills are like this. They are fighting with the disease in my body. (PB)
Another participant said:
When I started taking medication for HIV, I was taking a different kind of HIV treatment, I’m just not sure of their name but it was orange-ish in colour. Those pills, Eeeh, they were very strong. They would make me have scary dreams but with time when I changed to these pills that I am now taking, I am no longer experiencing those scary dreams. You understand. You also find my body itching but with these new pills, my body does not itch.(PA)
Another informant stated:
When I started taking my first HIV treatment, I would feel burning here (Points at stomach) ... I would feel some dizziness but they told me that after six day I will feel better and I should take treatment at night. Then after six days they changed me from taking the treatment at night and I then started taking it in the morning. I did have dizziness and feeling like I wanted to vomit but then I was fine. As time goes by, they would change containers which I don’t know if it’s still same treatment or what. Every February they would take blood and will then say now it’s alright. (PH)
Sub theme 3.2: Side effects to DTG based regimen
A small number of those interviewed started their HIV treatment journey on DTG based regimen and stated that they had experienced side effects of DTG.
One participant stated:
No, it has always been these ones which is the new treatment. Initially I would feel dizzy when taking the treatment. Sometimes I would feel like vomiting but never vomited and I would take water and sit down to relax then after ten to fifteen minutes I would feel better until they adjusted to my body. Now I am fine. (PE)
Another participant said:
Not really, at first when I started taking the new treatment, I was having problems with sleep. I was very energetic and that made me to have a hard time to sleep at night. I would be up until 2am that was the only thing. But they really helped me with the tiredness. I am more energetic now because of the pills and I am back at work, I am working well. I don’t have a problem. I am able to live like any person. (PL)
The results suggested that most of the interviewees had experienced side effects on their previous regimen. The experienced patients expressed negative comments about their previous regimen. A relatively small number of participants who started their treatment with only DTG based regimen did not experience side effects to the treatment at the early stages of starting treatment.
Theme 4: Reason for non-adherence to dolutegravir
Non-adherence to DTG based regimen was revealed by few participants and emerged as the theme with sub themes namely Alcohol use issue and work related issues.
Sub-theme 4.1: Alcohol use and work related issues
It was identified that alcohol use was a factor that made a few participants not to comply with their treatment. This was echoed as follows:
Eeeh, mostly when I skip, to be honest with you, let me not hid anything. Honestly, I skip due to taking alcohol. So, when I’m at a drinking place, I can’t take a pill and go with it in my pocket. The reason why the pills have to remain in its container is so that it is not exposed to air. So, if I am going to take it and put it in my pocket, then it will be exposed to air and will not work effectively as it would have had if it was in a container. (PA)
The same participant echoed that work related issues often affect his times of taking medication:
If I receive a sudden call that I am needed urgently maybe by family or a job since I am job-hunting and they say you have interview. When you get to Marble Hall, you take more time than expected and you get transport to go home late…. We are drinking treatment at a specific and same time, and I drink mine at 8 at night. So, at times I would get back home at past 8 or to 9 and then. According to what I told myself, if I missed time to take my treatment then I won’t take it until the following day. (PA)
Another participant said:
Well, I work as a taxi driver, and I do long distance trips from Marble hall to Pretoria. Sometimes I will go to Pretoria and come back this side late and it will be past my time of taking treatment. So, I take my treatment at 8 o’clock at night and it will be home. I don’t carry it with me to work because I know I am coming back. But now I am trying to make sure I am home before the time to take my treatment. (PE)
In summary, the findings on theme 4 revealed non-adherence to treatment from few participants. It was further outlined that reasons for non-adherence were patient factors rather than having side effects to the treatment.