A qualitative study of persons who are 100% adherent to antiretroviral therapy

Abstract

This qualitative study examined the medication-taking behaviors and attitudes of participants determined to be 100% adherers to antiretroviral therapy from a NIH-funded study testing a 12-week telephone adherence intervention. Using open-ended questions, interviewers collected data on a sample of 13 informants, whose medication adherence to a randomly selected antiretroviral medication was 100%, based on a 30-day data collection using electronic event monitoring (EEM). The analysis revealed 'successful medication management' as the core category or main theme. The participants achieved success with medication adherence through managing specific areas (regimen, self and environment). By adopting realistic expectations and pragmatic attitudes, adherence is fostered when medication taking is a priority, when patients believe in the efficacy of their medications and when there is a strong patient/provider relationship. Future research is needed to develop tailored interventions using strategies identified by this population. Further in-depth examination of medication-taking behaviors in 100% adherers may be useful in developing individualized programs to maximize adherence to antiretroviral therapy in the clinical setting.

An investigation of the determinants of adherence to highly active anti-retroviral therapy in Aboriginal men in the Downtown Eastside of Vancouver.

“…Usually, most patients who report adherence to treatment regimens also report greater social and emotional support from their health care providers and significant others (Morse et al, 1991). Conversely, adherent patients have been found to be those who live with others, have a partner, social or family support, engage in peer interaction, and have better physical interactions and relationships (Lewis et al, 2006).…”

“…On the other hand, for some patients, seeing an improvement in the immune and virologic indices used to monitor HAART (T-cells and HIV viral load) may encourage them to maintain adherence (Pratt et al, 1998). Furthermore, acknowledging the role of medication in avoiding illness and death, having a strong belief in the efficacy of one's medication have been reported to contribute to the facilitation of high adherence (Lewis et al, 2006). A given patients' own perceptions, beliefs, and expectations concerning their illness and its treatment are therefore important aspects that need to be assessed and determined in order to inform possible interventions directed towards the reinforcement of appropriate beliefs that enhance compliance.…”

“…An acceptance of the role of medication in avoiding severe illness and death (Lewis et al, 2006), as well as a history of opportunistic infection and more advanced disease or symptom severity (Bond & Hussar, 1991;Singh et al, 1996) have also been reported to contribute to high adherence (Lewis et al, 2006). Most of the study participants' responses, especially those who had been more sick or had been admitted to hospital before, and those who had seen a friend die of HIV/AIDS, were consistent with this literature and also in line with the health belief model.…”

“…Adjusting the HAART regimen by incorporating it into an individual patient's daily lifestyle and habit development is of utmost importance as it has been shown to increase adherence levels (Lewis et al, 2006). Furthermore, according to Lewis and colleagues (2006), patients that are better able to accept the trade-offs between the benefits of medication and its limitations, such as side effects, are able to more easily recognize the importance of adherence to HAART.…”

Advancing Pharmacy Practice Through Social Theory

“…26 Such complete adherence was found to be related to themes of drug regimen (tailoring medications to fit one's lifestyle, accepting limits and tradeoffs between drug side effects and positive clinical response, acknowledging the medication's effects in maintaining health), self (owning one's problems and solutions, investing in oneself, adopting a realistic outlook) and the environment (recognizing and using a support system, identifying and using personalized tools for adherence, having a positive partnership with the physician). Since this study was in 100% adherent people, no investigation into barriers to MA was possible.…”