Qualitative and quantitative assessments of HAART adherence of substance-abusing women

Abstract

This study was set up to examine factors affecting adherence to highly active antiretroviral therapy (HAART) by substance abusing women and to conduct a pilot study of a reminder device intervention. Three focus groups totaling 24 HIV-positive women developed priority lists of issues affecting adherence. Another group of 24 HIV-positive women received a timer-reminder with structured interviews on adherence at baseline and two monthly follow up intervals. Focus groups described key barriers to HAART adherence as substance abuse, forgetting, feeling ill, others' negative attitudes, obtaining refills and confidentiality. Primary disadvantages to HAART were side effects, pill-taking schedule and burden of taking medications. Facilitators included reminders (e.g. pill boxes) and spirituality. After receiving the reminder, missing a dose was less common (p < 0.05) due to sleeping through dose, being busy and feeling too good while a favourable trend (p = 0.07) was seen for change in daily routine and having too many pills to take. Although well accepted, the reminder did not affect the proportion missing a dose in the past two weeks: baseline (33%), first follow-up (30%) and second follow-up (30%). Forgetting to take HAART was only one of many cited barriers to adherence in these HIV-positive women; well-received reminder devices did not affect adherence. To improve substance-abusing women's adherence, multidimensional interventions are warranted.

Family Experiences with Pediatric Antiretroviral Therapy: Responsibilities, Barriers, and Strategies for Remembering Medications

“…28 "Forgetting" may be a proxy for psychological processes such as avoidance and denial. 59 Depression 5,60 and posttraumatic stress related to the HIV diagnosis, 61 other mental health problems, 56 and limited adherence-specific or global social support 56 may fuel this avoidance or otherwise make dose administration difficult if not impossible. Surely most caregivers want to their child to get this critical med-…”

Barriers to Antiretroviral Therapy Adherence and Plasma HIV RNA Suppression Among AIDS Clinical Trials Group Study Participants

“…For example, given that forgetting to take ART has been reported to be one of the most commonly stated adherence barriers, [12][13][14][15][16] many studies have examined the use of reminder devices in improving adherence. [17][18][19][20] However, most have not revealed clinically significant changes in adherence. Studies have reported other adherence barriers, including feeling depressed or overwhelmed, fear of disclosure, sleeping through a dose, substance use, regimen complexity, not having medication, change in daily routine, and not wanting to be reminded of HIV infection.…”

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

“…Studies indicate that procrastination and being too distracted or busy can lead to low HAART adherence (Hill, Kendall, & Fernandez, 2003;Powell-Cope et al, 2003;Westerfelt, 2004). One may procrastinate or be too busy or distracted due to work and/ or because they are searching for money to buy daily needs, among other reasons.…”