Email updates

Keep up to date with the latest news and content from BMC Public Health and BioMed Central.

Open Access Research article

Barriers to antiretroviral therapy adherence in rural Mozambique

Kate Groh1, Carolyn M Audet23*, Alberto Baptista4, Mohsin Sidat56, Alfredo Vergara23, Sten H Vermund267 and Troy D Moon267

Author Affiliations

1 Department of Medicine, D-3100, Medical Center North, Nashville, TN 37232-2358, USA

2 Department of Preventive Medicine, Village at Vanderbilt, Suite 2100,1500 21st Avenue South Nashville, TN 37212, USA

3 Vanderbilt Institute for Global Health, 2525 West End Ave, Suite 750, 2525 West End Ave, Nashville, TN, 37203, USA

4 Department of Pediatrics, 2200 Children's Way, Nashville, TN 37232, USA

5 Ministry of Health, Av. Quelimane: Av. 1 de Julho, Predio deo Monte Giro, Quelimane, Moçambique

6 Faculty of Medicine, University Eduardo Mondlane, PO Box 257, Maputo, Moçambique

7 Friends in Global Health, Avenida dos Trabalhadores N°424, Quelimane, Moçambique

For all author emails, please log on.

BMC Public Health 2011, 11:650  doi:10.1186/1471-2458-11-650

Published: 16 August 2011



HIV is treated as a chronic disease, but high lost-to-follow-up rates and poor adherence to medication result in higher mortality, morbidity, and viral mutation. Within 18 clinical sites in rural Zambézia Province, Mozambique, patient adherence to antiretroviral therapy has been sub-optimal.


To better understand barriers to adherence, we conducted 18 community and clinic focus groups in six rural districts. We interviewed 76 women and 88 men, of whom 124 were community participants (CP; 60 women, 64 men) and 40 were health care workers (HCW; 16 women, 24 men) who provide care for those living with HIV.


While there was some consensus, both CP and HCW provided complementary insights. CP focus groups noted a lack of confidentiality and poor treatment by hospital staff (42% CP vs. 0% HCW), doubt as to the benefits of antiretroviral therapy (75% CP vs. 0% HCW), and sharing medications with family members (66% CP vs. 0%HCW). Men expressed a greater concern about poor treatment by HCW than women (83% men vs. 0% women). Health care workers blamed patient preference for traditional medicine (42% CP vs. 100% HCW) and the side effects of medication for poor adherence (8% CP vs. 83% CHW).


Perspectives of CP and HCW likely reflect differing sociocultural and educational backgrounds. Health care workers must understand community perspectives on causes of suboptimal adherence as a first step toward effective intervention.

HIV; AIDS; Mozambique; antiretroviral therapy; adherence; compliance; health care workers; attitudes; behaviors; rural; focus groups