Skip to main content

Advertisement

SpringerLink
Log in

Qualitative analysis of barriers and facilitators encountered by HIV patients in an ART adherence programme

  • Research Article
  • Published:
International Journal of Clinical Pharmacy Aims and scope Submit manuscript

Abstract

Background Medication adherence is a complex, dynamic and changing behaviour that is affected by a variety of factors, including the patient’s beliefs and life circumstances. Studies have highlighted barriers to medication adherence (e.g., unmanaged side effects or a lack of social support), as well as facilitators of medication adherence (e.g., technical simplicity of treatment and psychological acceptance of the disease). Since August 2004, in Lausanne (Switzerland), physicians have referred patients who are either experiencing or are at risk of experiencing problems with their HIV antiretroviral treatment (ART) to a routine interdisciplinary ART adherence programme. This programme consists of multifactorial intervention including electronic drug monitoring (MEMSTM). Objective This study’s objective was to identify the barriers and facilitators encountered by HIV patients with suboptimal medication adherence (≤90 % adherence over the study period). Setting The community pharmacy of the Department of Ambulatory Care and Community Medicine in Lausanne (Switzerland). Method The study consisted of a retrospective, qualitative, thematic content analysis of pharmacists’ notes that were taken during semi-structured interviews with patients and conducted as part of the ART adherence programme between August 2004 and May 2008. Main outcome measure Barriers and facilitators encountered by HIV patients. Results Barriers to and facilitators of adherence were identified for the 17 included patients. These factors fell into three main categories: (1) cognitive, emotional and motivational; (2) environmental, organisational and social; and (3) treatment and disease. Conclusion The pharmacists’ notes revealed that diverse barriers and facilitators were discussed during medication adherence interviews. Indeed, the results showed that the 17 non-adherent patients encountered barriers and benefited from facilitators. Therefore, pharmacists should inquire about all factors, regardless of whether they have a negative or a positive impact on medication adherence, and should consider all dimensions of patient adherence. The simultaneous strengthening of facilitators and better management of barriers may allow healthcare providers to tailor care to a patient’s specific needs and support each individual patient in improving his medication-related behaviour.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sethi AK. Adherence and HIV drug resistance. Hopkins HIV Rep. 2004;16(1):6–8.

    PubMed  Google Scholar 

  2. Sterne JA, Hernan MA, Ledergerber B, Tilling K, Weber R, Sendi P, et al. The Swiss HIV Cohort Stud. Long-term effectiveness of potent antiretroviral therapy in preventing AIDS and death: a prospective cohort study. Lancet. 2005;366(9483):378–84.

    Article  CAS  PubMed  Google Scholar 

  3. Wagels T, Amiet R, Battegay M, Guex AC, Opravil M, Vernazza PL, The Swiss HIV Cohort Study Group. Predictive value of adherence in patients starting highly active antiretroviral treatment for HIV infection. Swiss MedWkly. 2004;134(45–46):678–80.

  4. Glass TR, de Geest S, Weber R, Vernazza PL, Rickenbach M, Furrer H, et al. Correlates of self-reported non-adherence to antiretroviral therapy in HIV-infected patients: the Swiss HIV Cohort Study. J Acquir Immune Defic Syndr. 2006;41(3):385–92.

    Article  PubMed  Google Scholar 

  5. Ammassari A, Trotta MP, Murri R, Castelli F, Narciso P, Noto P, et al. Correlates and predictors of adherence to highly active antiretroviral therapy: overview of published literature. J Acquir Immune Defic Syndr. 2002;31(Suppl 3):S123–7.

    Article  PubMed  Google Scholar 

  6. Gebrekristos HT, Mlisana KP, Karim QA. Patients’ readiness to start highly active antiretroviral treatment for HIV. BMJ. 2005;331(7519):772–5.

    Article  PubMed Central  PubMed  Google Scholar 

  7. Murphy DA, Roberts KJ, Martin DJ, Marelich W, Hoffman D. Barriers to antiretroviral adherence among HIV-infected adults. AIDS Patient Care STDS. 2000;14(1):47–58.

    Article  CAS  PubMed  Google Scholar 

  8. Remien RH, Hirky AE, Johnson MO, Weinhardt LS, Whittier D, Le GM. Adherence to medication treatment: a qualitative study of facilitators and barriers among a diverse sample of HIV + men and women in four US cities. AIDS Behav. 2003;7(1):61–72.

    Article  PubMed  Google Scholar 

  9. Horne R, Cooper V, Gellaitry G, Date HL, Fisher M. Patients’ perceptions of highly antiretroviral therapy in relation to treatment uptake and adherence: the utility of the necessity-concerns framework. J Acquir Immune Defic Syndr. 2007;45(3):334–41.

    PubMed  Google Scholar 

  10. Roberts KJ. Barriers to and facilitators of HIV-positive patients’ adherence to antiretroviral treatment regimens. AIDS Patient Care STDS. 2000;14(3):155–68.

    Article  CAS  PubMed  Google Scholar 

  11. Beusterien KM, Davis EA, Flood R, Howard K, Jordan J. HIV patient insight on adhering to medication: a qualitative analysis. AIDS Care. 2008;20(2):244–52.

    Article  CAS  PubMed  Google Scholar 

  12. Vervoort SC, Borleffs JC, Hoepelman AI, Grypdonck MH. Adherence in antiretroviral therapy: a review of qualitative study. AIDS. 2007;21(3):271–81.

    Article  PubMed  Google Scholar 

  13. Vervoort SC, Grypdonck MH, de Grauwe A, Hoeperlman AI, Borleffs JC. Adherence to HAART: processes explaining adherence behaviour in acceptors and non-acceptors. AIDS Care. 2009;21(4):431–8.

    Article  PubMed  Google Scholar 

  14. Norton WE, Amico KR, Fisher WA, Shuper PA, Ferrer RA, Cornmann DF, et al. Information-motivation-behavioural skills barriers associated with intentional versus unintentional ARV non-adherence behavior among HIV + patients in clinical care. AIDS Care. 2010;22(8):979–87.

    Article  PubMed  Google Scholar 

  15. Sidat M, Fairley C, Grierson J. Experiences and perceptions of patients with 100% adherence to highly active antiretroviral therapy: a qualitative study. AIDS Patients Care STDS. 2007;21(7):509–20.

    Article  Google Scholar 

  16. Krummenacher I, Cavassini M, Bugnon O, Schneider MP. An interdisciplinary HIV-adherence program combining motivational interviewing and electronic antiretroviral drug monitoring. AIDS Care. 2011;23(5):550–61.

    Article  PubMed  Google Scholar 

  17. Miller WR, Rollnick S, Conforti K. Motivational interviewing: preparing people for change, 2nd ed. New York: The Guilford Press; 2002. ISBN 1572305630, 978-1572305632.

  18. Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, Wu P, et al. Adherence to HAART: a systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med. 2006;3(11):e438.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Russel CK, Bunting SM, Graney M, Hartig MT, Kisner P, Brown B. Factors that influence the medication decision making of persons with HIV/AIDS: a taxonomic exploration. J Assoc Nurses AIDS Care. 2003;14(4):46–60.

    Article  Google Scholar 

  20. Simoni JM, Frick PA, Huang B. A longitudinal evaluation of a social support model of medication adherence among HIV-positive men and women on antiretroviral therapy. Health Psychol. 2006;25(1):74–81.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We acknowledge the members of the Swiss HIV Cohort Study for their support.

Funding

None.

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, University of Lausanne, Geneva, Switzerland

    Isabelle Krummenacher, Olivier Bugnon & Marie P. Schneider

  2. Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital, Lausanne, Switzerland

    Brenda Spencer

  3. Community Pharmacy, Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland

    Sophie Du Pasquier, Olivier Bugnon & Marie P. Schneider

  4. Service of Infectious Disease, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland

    Matthias Cavassini

  5. Community Pharmacy, Pharmacie de la Policlinique Médicale Universitaire, 44 Rue du Bugnon, 1011, Lausanne, Switzerland

    Marie P. Schneider

Authors
  1. Isabelle Krummenacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Brenda Spencer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sophie Du Pasquier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olivier Bugnon
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Matthias Cavassini
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Marie P. Schneider
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Marie P. Schneider.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Krummenacher, I., Spencer, B., Du Pasquier, S. et al. Qualitative analysis of barriers and facilitators encountered by HIV patients in an ART adherence programme. Int J Clin Pharm 36, 716–724 (2014). https://doi.org/10.1007/s11096-014-9930-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11096-014-9930-0

Keywords

Search

Navigation