1.1 Background to the Study
The Human Immunodeficiency Virus (HIV) belongs to the family of ‘retroviruses’and possesses the ability to transform its genetic material from viral ribonucleic acid (RNA) into deoxyribonucleic acid (DNA) and then subsequently integrate the latter into the genome of an infected human cell(Maartens, Celum, & Lewin, 2014). These processes, referred to as reverse transcription and integration, combined with a high mutagenicity currently constitute significant barriers to the creation of a cure for the virus. Antiretroviral medications (ARVs) interfere with replication of the virus in specific cells of the immune system (expressing CD4 receptors on their cell surfaces) through varying mechanisms resulting in virologic suppression; characterized by an undetectable level of the virus in the human circulatory system and represents the primary goal of antiretroviral therapy. Indirect benefits that follow virologic suppression include recovery of the immune system; a reduction in AIDS related morbidity; an improved life expectancy and a significant reduction in the risk of transmission of the virus(Cohen, et al., 2016).
The receipt of antiretroviral medications is therefore a lifelong process and for HIV-infected persons to benefit maximally from ARV therapy, they must be optimally retained in care. Retention in HIV care describes the continuous and uninterrupted receipt of comprehensive HIV care and treatment services following HIV diagnosis and successful linkage to care and is an important health behaviour necessary to ensure continuous receipt of antiretroviral medications; evaluation of drug toxicities; early identification of treatment failure(Geng, et al., 2010); and ongoing receipt of comprehensive health education that in turn promotes medication adherence.