International Journal of Clinical Pharmacy

, Volume 36, Issue 2, pp 352–359 | Cite as

Knowledge of HIV and its treatment among health care providers in South Africa

  • Karine Wabø Ruud
  • Sunitha C. Srinivas
  • Else-Lydia ToverudEmail author
Research Article


Background In South Africa, availability of antiretroviral (ARV) drugs has increased largely in the public sector since it became available in 2004. Follow-up of stabilized patients on ARV drugs are done in primary health care (PHC) facilities run by nurses, often without specialized training. This has deep impact on the patients’ drug adherence. Objective To investigate health care providers’ (HCPs) knowledge about human immunodeficiency virus (HIV) and antiretroviral therapy (ART) in the Eastern Cape Province, South Africa. The aim was also to investigate nurses’ knowledge and experience regarding adverse drug reaction (ADR) reporting. Setting Public PHC clinics in one district of the Eastern Cape Province. Method Personal interviews, using a structured questionnaire, were conducted with 102 HCPs (nurses and auxiliary staff) working at six PHC facilities, one community health centre and one health post. Main outcome measure Knowledge about HIV and ART among nurses and auxiliary staff. Results Both nurses and auxiliary staff had some basic knowledge about symptoms of HIV and modes of transmission, but great uncertainty was seen regarding specific topics including ARV drugs, ADRs and HIV complications. The PHC staff were uncertain about how to administer ARV drugs—with or without food—and some of them would advice their patients not to take ARV drugs at times when food was lacking. Both nurses and auxiliary staff knew that HIV was treated with ARV drugs. Only 60 % of the HCPs claimed that ART was the only effective treatment for HIV, whereas 39 % claimed that nutritious food also could treat HIV. Nurses showed lacking ability to manage ADRs. They also had very little knowledge about ADR reporting, and very few had ever submitted a report at all. Conclusion The study shows that both nurses and auxiliary staff are unable to provide the patients with adequate advice about administration of the ARV drugs and management of ADRs. Serious lack of knowledge among HCPs regarding the treatment of HIV presents structural barriers to the patients’ adherence.


ADRs HIV/AIDS Nurses Primary health care South Africa Training 



The authors are grateful to all the participants from the PHC clinics involved in the study.


Norwegian Pharmaceutical Society.

Conflicts of interest

The authors declare no conflicts of interest.


  1. 1.
    Joint United Nations Programme on HIV/AIDS. Global report: UNAIDS report on the global aids epidemic 2010: UNAIDS; 2010. ISBN: 978-92-9173-871-7. Accessed 21 Aug 2013.
  2. 2.
    Shisana O, Rehle T, Simbayi L, Zuma K, Jooste S, Pillay-van-Wyk V et al. South African national HIV prevalence incidence, behaviour and communication survey 2008: a turning tide among teenagers? Cape Town: HSRC Press; 2009. ISBN (pdf) 978-0-7969-2292-2. Accessed 21 Aug 2013.
  3. 3.
    Health and Development Africa (Pty) Ltd. Country progress report on the declaration of commitment on HIV/AIDS. 2010 report; 2010.…/Report/2010/southafrica_2010_country_progress_report_en.pdf. Accessed 21 Aug 2013.Google Scholar
  4. 4.
    World Health Organization, UNAIDS. AIDS epidemic update: November 2009. Geneva, Switzerland; 2009. ISBN 978-92-9173-832-8. Accessed 21 Aug 2013.
  5. 5.
    Groenewald P, Bradshaw D, Daniels J, Matzopoulos R, Bourne D, Blease D et al. Cause of death and premature mortality in Cape Town, 2001-2006. Cape Town: South African Medical Research Council; 2008. ISBN: 978-1-920014-63-6. Accessed 21 Aug 2013.
  6. 6.
    Mascolini M, Zuniga JM. Perceptions of health, HIV disease, and HIV treatment by patients in 6 regions: analysis of the 2555-person AIDS treatment for life international survey. J Int Assoc Physicians AIDS Care (Chic). 2008;7:160–77.CrossRefGoogle Scholar
  7. 7.
    Health Systems Trust. South African health review 2010. Durban: HST; 2010. ISBN: 978-1-919839-69. Accessed 20 Aug 2013.
  8. 8.
    Ojikutu B, Jack C, Ramjee G. Provision of antiretroviral therapy in South Africa: unique challenges and remaining obstacles. J Infect Dis. 2007;196:S523–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Grubb I, Perriëns J, Schwartländer B. A public health approach to antiretroviral treatment: overcoming constraints: World Health Organization; 2003. ISBN: 92-4-159085-8. Accessed 21 Aug 2013.
  10. 10.
    World Health Organization. The global shortage of health workers and its impact; 2006.Google Scholar
  11. 11.
    World Health Organization. Working together for health. The world health report 2006. Geneva: WHO; 2006.Google Scholar
  12. 12.
    Ruud KW, Toverud E-L, Radloff S, Srinivas SC. Antiretroviral treatment and follow-up of HIV-infected patients by health care providers in South African public primary health care. J Assoc Nurses AIDS Care. 2010;21:417–28.PubMedCrossRefGoogle Scholar
  13. 13.
    Dohrn J, Nzama B, Murrman M. The impact of HIV scale-up on the role of nurses in South Africa: time for a new approach. J Acquir Immune Defic Syndr. 2009;52:S27–9.PubMedCrossRefGoogle Scholar
  14. 14.
    Mehta U, Durrheim DN, Blockman M, Kredo T, Gounden R, Barnes KI. Adverse drug reactions in adult medical inpatients in a South African hospital serving a community with a high HIV/AIDS prevalence: prospective observational study. Br J Clin Pharmacol. 2007;65:396–406.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    National Department of Health South Africa. Clinical guidelines for the management of HIV and AIDS in adults and adolescents. 2010.Google Scholar
  16. 16.
    Horwood C, Voce A, Vermaak K, Rollins N, Qazi S. Routine checks for HIV in children attending primary health care facilities in South Africa: attitudes of nurses and child caregivers. Soc Sci Med. 2010;70:313–20.PubMedCrossRefGoogle Scholar
  17. 17.
    Shah S, Rollins N, Bland R, Child Health Group. Breastfeeding knowledge among health workers in rural South Africa. J Trop Pediatr. 2005;51:33–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Dijkstra A, Kangawaza E, Martens C, Boer H, Rasker J. Knowledge about HIV/AIDS and policy knowledge in a South African state hospital. SAHARA J. 2007;4:636–9.PubMedCrossRefGoogle Scholar
  19. 19.
    Delobelle P, Rawlinson J, Ntuli S, Malatsi I, Decock R, Depoorter A. HIV/AIDS knowledge, attitudes, practices and perceptions of rural nurses in South Africa. J Adv Nurs. 2009;65:1061–73.PubMedCrossRefGoogle Scholar
  20. 20.
    McKenna HP, Hasson F, Keeney S. Patient safety and quality of care: the role of the health care assistant. J Nurs Manag. 2004;12:452–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Hall EJ. Nursing attrition and the work environment in South African health facilities. Curationis. 2004;27:28–36.PubMedCrossRefGoogle Scholar
  22. 22.
    Ransom J, Johnson A. Key findings: a qualitative assessment of provider and patient perceptions of HIV/AIDS in South Africa. Soc Work Health Care. 2009;24:47–59.Google Scholar
  23. 23.
    Mavhandu-Mudzusi A, Netshandama V, Davhana-Maselesele M. Nurses’ experiences of delivering voluntary counseling and testing services for people with HIV/AIDS in the Vhembe District, Limpopo Province, South Africa. Nurs Health Sci. 2007;9:254–62.PubMedCrossRefGoogle Scholar
  24. 24.
    Ruud KW, Srinivas SC, Toverud E-L. Addressing gaps in pharmacovigilance practices in the antiretroviral therapy program in the Eastern Cape Province, South Africa. Res Social Adm Pharm. 2010;6:345–53.PubMedCrossRefGoogle Scholar
  25. 25.
    Ruud KW, Srinivas SC, Toverud E-L. Healthcare providers’ experiences with adverse drug reactions and adherence challenges in antiretroviral therapy of HIV patients in the Eastern Cape Province, South Africa. Eur J Clin Pharmacol. 2012;68:1321–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Botha C. Excerpt from judgment TAC and others v minister of health and others: judge of the high court South Africa 2001.Google Scholar
  27. 27.
    South African Government Information. Statement of cabinet on HIV/AIDS. In: Department of Health South Africa, ed.: Government Communications; 2002.Google Scholar
  28. 28.
    Boulle A, Van Cutsem G, Hilderbrand K, Cragg C, Abrahams M, Mathee S, et al. Seven-year experience of a primary care antiretroviral treatment programme in Khayelitsha, South Africa. AIDS. 2010;24:563–72.PubMedCrossRefGoogle Scholar
  29. 29.
    Lundgren JD, Lazarus JV. Dampening the effect of drug resistance in HIV: a leap forward. Lancet Infect Dis. 2012;12:91–2.PubMedCrossRefGoogle Scholar
  30. 30.
    Bogart LM, Skinner D, Weinhardt LS, Glasman L, Sitzler C, Toefy Y, et al. HIV/AIDS misconceptions may be associated with condom use among black South Africans: an exploratory analysis. Afr J AIDS Res. 2011;10:181–7.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Nattrass N. AIDS and the scientific governance of medicine in post-apartheid South Africa. Afr Aff. 2008;107:157–76.CrossRefGoogle Scholar
  32. 32.
    Kapp C. South African Health Minister must go, say scientists. Lancet. 2006;368:1141–2.PubMedCrossRefGoogle Scholar
  33. 33.
    Global AIDS respons progress report 2012: Republic of South Africa: Health and Development Africa (Pty) Ltd, National Department of Health, South African National AIDS Council.Google Scholar
  34. 34.
    Weiser SD, Tuller DM, Frongillo EA, Senkungu J, Mukiibi N, Bangsberg DR. Food insecurity as a barrier to sustained antiretroviral therapy adherence in Uganda. PLoS ONE. 2010;5:1–8.CrossRefGoogle Scholar
  35. 35.
    Goudge J, Ngoma B. Exploring antiretroviral treatment adherence in an urban setting in South Africa. J Public Health Policy. 2011;32:52–64.CrossRefGoogle Scholar
  36. 36.
    Penn C, Watermeyer J, Evans M. Why don’t patients take their drugs? The role of communication, context and culture in patient adherence and the work of the pharmacist in HIV/AIDS. Patient Educ Couns. 2011;83:310–8.PubMedCrossRefGoogle Scholar
  37. 37.
    Coetzee B, Kagee A, Vermeulen N. Structural barriers to adherence to antiretroviral therapy in a resource-constrained setting: the perspectives of health care providers. AIDS Care. 2011;23:146–51.PubMedCrossRefGoogle Scholar
  38. 38.
    Rose D, Charlton KE. Prevalence of household food poverty in South Africa: results from a large, nationally representative survey. Public Health Nutr. 2002;5:383–9.PubMedCrossRefGoogle Scholar
  39. 39.
    Chopra M, Puoane T. Prevention of diabetes throughout an obesogenic world. Diabetes Voice. 2003;48:24–6.Google Scholar
  40. 40.
    Kruger H, Puoane T, Senekal M, van der Merwe M. Obesity in South Africa: challenges for government and health professionals. Public Health Nutr. 2005;8:491–500.PubMedCrossRefGoogle Scholar
  41. 41.
    Health Systems Trust. South African health review 2008. Durban: Health Systems Trust; 2008. ISBN: 1-919839-62-3. Accessed 21 Aug 2013.
  42. 42.
    Fomundam H, Meyers G, Kayongo D. Models of care project (HIV/AIDS treatment programme). Pharmacovigilance plan and training, Grahamstown Settlers hospital. Eastern Cape Regional Training Centre (ECRTC) 2007.Google Scholar

Copyright information

© Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie 2013

Authors and Affiliations

  • Karine Wabø Ruud
    • 1
  • Sunitha C. Srinivas
    • 2
  • Else-Lydia Toverud
    • 1
    Email author
  1. 1.Department of Social Pharmacy, School of PharmacyUniversity of OsloOsloNorway
  2. 2.Faculty of Pharmacy, Pharmacy Administration and PracticeRhodes UniversityGrahamstownSouth Africa

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