The paper, published in The Lancet Infectious Diseases journal, said poor administration of the drug, in terms of regularly taking the right levels of Tenofovir could be an explanation for the discrepancy.
HIV was resistant to Tenofovir in 60 percent of cases in several African countries, according to the study, covering the period from 1998 to 2015.
The research, led by University College London, looked at around 2 000 HIV patients worldwide. Given relatively high levels of adherence to HIV treatment in Africa, it becomes more relevant to explore factors affecting adherence in Zimbabwe at a time many success stories have been written.
While ART adherence is even better in Zimbabwe than in some countries in sub-Saharan Africa, such as Tanzania and Mozambique we have a few problems of our own.
Experience has shown that HIV care and treatment is complex and drug regimens must be carefully adhered to.
Sadly despite plenty of information and HIV awareness raising campaigns, in Zimbabwe adherence is often inhibited by stigma.
HIV is still associated with promiscuity and sort of criminalised by society especially in urban areas. There are some people who still treat HIV positive people like criminals.
Then the other challenge is social constructions of masculinity. These interfere with both men and women’s ART adherence as many women if found HIV positive usually take time to tell their partners for fear of being labelled or even divorced. Such women secretly take their medication and have problems adhering when they cannot access it.
Other people fear disclosing their HIV status to friends and family fearing the lack of support.
In the cities, people hide their status, not because they are ashamed but fear the stigma that comes once they start talking about it.
This is unacceptable given the amount of work Government and NGOs and other development partners have put in fighting HIV stigma.
But, people in rural areas seem more comfortable about their HIV status and can openly talk about it. Maybe this is because of the social make up in such areas.
In rural areas most people adhere to their medication as they have come to accept that HIV is just like any condition.
Most rural areas in Zimbabwe have the most successful peer support groups.
The visibility of community health workers has made the situation better as these always check and advise both HIV positive and negative villagers.
Traditional leadership in rural areas has been in the fore in fighting stigma and encouraging men to get tested and know their status.
For example some chiefs in Masvingo Province encourage all men to accompany their pregnant wives to health facilities for HIV testing. Those who fail to do so are fined a goat. This has helped HIV positive pregnant women to take ART without hiding their status and adhere to their medication. The men are also educated about HIV and become champions.
In Zimbabwe some religious beliefs have also played a role in affecting adherence.
Some HIV positive people have gone to some churches, been prayed for and told they have been cured and therefore should throw away their medication. Sadly such people become ill after some time and die.
Others have also been told by herbal supplements providers that if they drink certain herbs they will be cured of HIV.
Such people have also discarded their medication also to fall very sick.
This has proven expensive for governments taking into account the case of tuberculosis treatment defaulters.
For instance Government only uses $15 to treat each person with common TB.
Government has to fork out more for defaulters who would have developed multi drug resistant (MDR) TB each person requiring US$1 500.
This is totally unacceptable and costly for the country.
In some cases, poor services especially for the youth, long waiting times, dejected underpaid nurses, poor transport systems and poor communication between service users and providers also deter some ART users from adhering to treatment plans.
Illegal migration into neighbouring countries has also affected adherence.
Most of the illegal migrants do not access health services for fear of being deported and stop taking their medication for as long as they are fit — that is if no one back home collects for them and posts.
Then there is the issue of children’s ART especially when that child’s status has not been disclosed to all caregivers like the housemaid.
Some housemaids, who spend most time with kids, may forget to give the child his or her medication and depending on the age, the child may not be able to communicate that they have not been adhering to their treatment regimen.
The bottom line is adherence is critical and people taking anti-retroviral drugs should adhere to their treatment regimens so that they do not develop resistance, reversing recovery benefits and incurring huge health care costs.
If one defaults on treatment for whatever reason, the virus mutates and becomes resistant to drugs being taken
It then becomes expensive to move a patient from the first line of treatment to the second line.