Barriers to antiretroviral adherence among HIV-infected adults

Success of highly active antiretroviral therapies (HAART) relies on HIV-inf ected patients being able to adhere to complicated treatment regimens for e xtremely long periods of time. Four focus groups With patients taking antir etrovirals (N = 39) were conducted to: (1) determine what strategies facili tate successful adherence; (2) determine what barriers prevent adherence; a nd (3) investigate the health-care provider and patient relationship and ho w it may impact adherence. Quantitative and qualitative information was gat hered. Participants were prescribed an average of 15 pills per day (M = 14. 7, SD = 6.3, range 4 to 36). Findings from the quantitative data revealed t hat the three strategies used most often to aid adherence were: carrying sp ecial containers for medication; having a health-care provider explain or c larify medication requirements; and carrying food and water for adherence t o special instructions. The most difficult barriers for patients were sleep ing through dose time, problems in following special instructions, and chan ges in daily routines. From the qualitative data, four main categories of b arriers and aids to adherence emerged: patient characteristics, the health- care provider-patient relationship, the health-care system, and issues rela ted to the medication regimen. Barriers related to the health care provider -patient relationship included patient satisfaction with their provider, as well as quality of communication with the provider. In addition, health-ca re system barriers caused difficulty in maintaining adherence. Implications for patient as well as provider interventions are discussed.