Adherence to HAART: Perspectives from clients in treatment support programs

Abstract

The development of highly active antiretroviral therapy (HAART) has resulted in dramatic decreases in morbidity and mortality for HIV-infected individuals. Because the long-term efficacy of HAART is dependent on near perfect adherence, many providers offer services to support adherence, including education, regimen review, counseling, and reminder tools. Little is known regarding the utilization or efficacy of these services. In this paper, we report on data collected during 32 open-ended interviews conducted with individuals receiving services through the New York State Treatment Adherence Demonstration Project. Participants in the project reported deriving benefits from a broad range of project activities. Educational efforts helped clients to recognize HIV as a manageable, rather than terminal, illness. Information and tools focused on specific regimens provided clients with concrete knowledge and skills. Effective communication with medical providers and pharmacists was facilitated by adherence staff who proactively advocated for client needs. Program-based social support was particularly valuable for many participants, helping them to retain needed motivation and strength. Educational, practical, and supportive services were all considered valuable to clients participating in adherence support programs. A mix of services may best meet the range of needs found among persons taking HAART.

Barriers and facilitators of interventions for improving antiretroviral therapy adherence: a systematic review of global qualitative evidence

“…All studies were conducted in a single country. Twelve studies were conducted in high-income countries (HICs: Canada and United States) [33,34,40,44–46,48–52,56], 13 in middle-income countries (MICs: Brazil, China, India, Nigeria, Peru, Romania, South Africa, Swaziland, Thailand and Zambia) [15,17,30–32,36,38,41–43,47,53,54] and six in low-income countries (LICs: Mozambique, Rwanda, Tanzania, Uganda and Zimbabwe) [16,29,35,37,55]. The overall studies focused on children living with HIV (two studies) [30,54], adolescents (four studies) [43,45,48,53], adults (21 studies) [15,16–37,39–41,44,46,49–52,54,56] and pregnant women (one study) [55].…”

“…Twenty-three studies provided detailed experiences of PLHIV [15,17,29,32–37,39,40,44–46,48–56]. Thirteen studies explored the experiences of healthcare providers and lay health workers in addition to the experiences of PLHIV [15,16,31,33,35,37,38,41–43,47,54,55].…”

Factors of interpersonal communication and behavioral health on medication self-efficacy and medication adherence

“…Social support PLWH who report high levels of social support from family, friends, or healthcare providers are more likely to adhere than those with lower levels of support (Barclay et al, 2007;Catz, Kelly, Bogart, Benotsch, & McAuliffe, 2000;Gonzalez, Penedo, Dur, Antoni, & Horne, 2007;Langebeek et al, 2014;Simoni, Frick, & Huang, 2006;Weiss et al, 2006). Whereas some researchers identified a direct relationship between social support and medication adherence (Gonzalez et al, 2007), others found that the relationship between social support and medication adherence is mediated by other factors, such as depression and self-efficacy (Simoni et al, 2006).…”

Use of pragmatic community-based interventions to enhance recruitment and adherence in a randomized trial of Tai Chi for women with osteopenia

“…50, 52, 53 In this study, participant connection with other students may have motivated them to attend classes more frequently. Although some degree of both instructor and social support would have been inherent to predetermined cohorts and hospital-situated classes, the level of support in this study was enhanced by the community-based classes, thus underscoring the influence of the pragmatically delivered Tai Chi intervention.…”

“…Several qualitative studies exploring adherence have demonstrated that forming supportive bonds with instructors has a positive influence on adherence to a variety of interventions including exercise programs and medication regimens. 50–53 …”