Client and Provider Perspectives on Antiretroviral Treatment Uptake and Adherence Among People Who Inject Drugs in Indonesia, Ukraine and Vietnam: HPTN 074
HIV-infected people who inject drugs (PWID) have low uptake of HIV services, increasing the risk of transmission to uninfected injection or sexual partners and the likelihood of AIDS-related deaths. HPTN 074 is a vanguard study assessing the feasibility of an integrated intervention to facilitate treatment as prevention to PWID in Indonesia, Ukraine, and Vietnam. We describe barriers to and facilitators of ART uptake and adherence among PWID. We conducted in-depth interviews with 62 participants, including 25 providers and 37 PWID at baseline across all sites. All interviews were recorded, transcribed, translated into English and coded in NVivo for analysis. Matrices were developed to identify emergent themes and patterns. Overall, differences between provider and PWID perspectives were greater than differences in cross-site perspectives. Providers and PWID recognized clinic access, financial barriers, side effects, and lack of information about HIV testing and ART enrollment as barriers to ART. However, providers tended to emphasize individual level barriers to ART, such as lack of motivation due to drug use, whereas PWID highlighted health systems barriers, such as clinic hours and financial burden, fears, and side effects. Providers did not mention stigma as a barrier though their language reflected stereotypes about drug users. The differences between provider and PWID perspectives suggest a gap in providers’ understanding of PWID. This misunderstanding has implications for patient-provider interactions that may affect PWID willingness to access care or adhere to ART. Lessons learned from this study will be important as countries with a significant HIV burden among PWID design and implement programs to engage HIV-infected PWID in care and treatment.
KeywordsHIV/AIDS Antiretroviral treatment uptake Antiretroviral treatment adherence People who inject drugs Indonesia Ukraine Vietnam
We would like to thank the members of the HPTN 074 study site teams for their hard work and dedication to this project, including Kristiana Siste and Lidya Heryanto of the Psychiatric Department at the University of Indonesia for conducting all in-depth interviews at the Indonesia site; Olena Makarenko, MD, PhD, Irina Zaviryukha, MD, Svitlana Antonyak, MD at the Ukraine site; and Vu Thanh Nhan and Nguyen Nhu Trang for conducting all interviews at the Vietnam site. We are grateful for the support from NGO “Club Eney”; Gromashevsky Institute of Epidemiology and Infectious Diseases; and the Viet Nam Administration for HIV/AIDS Control (VAAC). Lastly, we would like to thank the participants for their invaluable contributions to this research.
This work was supported by the National Institute of Allergy and Infectious Diseases (NIAID), the National Institute of Mental Health (NIMH), and the National Institute on Drug Abuse (NIDA) of the National Institutes of Health (NIH); Award Numbers UM1AI068619 [HPTN Leadership and Operations Center], UM1AI068617 [HPTN Statistical and Data Management Center], UM1AI068613 [HPTN Laboratory Center], and the University of North Carolina at Chapel Hill Center for AIDS Research (P30 AI50410). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.
Compliance with Ethical Standards
Conflict of interest
Vivian F. Go declares that she has no conflict of interest. Rebecca B. Hershow declares that she has no conflict of interest. Tetiana Kiriazova declares that she has no conflict of interest. Quynh Bui declares that she has no conflict of interest. Carl A. Latkin declares that he has no conflict of interest. Scott Rose declares that he has no conflict of interest. Erica Hamilton declares that she has no conflict of interest. Kathryn E. Lancaster declares that she has no conflict of interest. David Metzger declares that he has no conflict of interest. Irving F. Hoffman declares that he has no conflict of interest. William C. Miller declares that he has no conflict of interest.
All procedures performed in studies involving human subjects were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
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