Barriers and Enablers for Adherence to Antiretroviral Therapy Among People Living With HIV/AIDS in the Era of COVID-19: A Qualitative Study From Pakistan

Abstract

Background: With the increased availability of safe antiretroviral therapy (ART) in recent years, achieving optimal adherence and patient retention is becoming the biggest challenge for people living with HIV (PLWH). Care retention is influenced by several socioeconomic, socio-cultural, and government policies during the COVID-19 pandemic. Therefore, we aim to explore barriers and facilitators to adherence to ART among PLWH in Pakistan in general and COVID-19 pandemic related in particular.Methods: Semi-structured interviews were conducted among 25 PLWH from December 2020 to April 2021 in the local language (Urdu) at the ART centre of Pakistan Institute of Medical Sciences, Islamabad, Pakistan. Interviews were audio-recorded in the local Urdu language, and bilingual expert (English, Urdu) transcribed verbatim, coded for themes and sub-themes, and analyzed using a phenomenological approach for thematic content analysis.Results: Stigma and discrimination, fear of HIV disclosure, economic constraints, forgetfulness, religion (Ramadan, spiritual healing), adverse drug reactions, lack of social support, alternative therapies, and COVID-19-related lock-down and fear of lesser COVID-19 care due to HIV associated stigma were identified as barriers affecting the retention in HIV care. At the same time, positive social support, family responsibilities, use of reminders, the beneficial impact of ART, and initiation of telephone consultations, courier delivery, and long-term delivery of antiretrovirals during COVID-19 were identified as facilitators of HIV retention.Conclusion: Improving adherence and retention is even more challenging due to COVID-19; therefore, it requires the integration of enhanced access to treatment with improved employment and social support. HIV care providers must understand these reported factors comprehensively and treat patients accordingly to ensure the continuum of HIV care. A coordinated approach including different stakeholders is required to facilitate patient retention in HIV care and consequently improve the clinical outcomes of PLWH.

The impacts of COVID-19 pandemic on service delivery and treatment outcomes in people living with HIV: a systematic review

“…The studies carried out among PLHIV reported alterations in ART uptake as follows: a rate of 33.7%,less-than-excellent and 1.7% under-average adherence to antiretrovirals medications [ 22 ], an increase of 7% (from 5 to 12%) in the rate of non-adherence to HIV medications [ 23 ], a 23.1% decrease in obtaining antiretroviral medication[ 24 ], a rate of 8.2% one-dose-ART-medication miss and 13.2% ART uptake avoidance [ 25 ], 5% to 26% increase in the chance of ART supply failure [ 26 ], a 36% temporary non-adherence due to inadequate ART supply [ 27 ], a 13.25% rate of running out of ART medication during pandemic [ 28 ], a 27.4% rate of missing visits for the antiretroviral stock refill [ 29 ], a 3% decrease in ART uptake [ 30 ], a 24.0% rate of missing at least one dose of HIV medications [ 31 ], and a 3.6% of ART refill failure [ 21 ]. In addition, one study conducted among providers reported a 67.25% rate of ART-application-service suspension or postponement due to the COVID-19 pandemic [ 32 ].…”

“…Many patients had missed their HIV clinical visits, recovery support meetings, follow-up tests, and counseling services. The main causes of this general decline in clinical appointments were reported as follows: inadequate transport, police abuse, insufficient transportation funds to avoid exposure to COVID-19 [ 27 ], lockdowns [ 28 ], limited access to health services, reduced income, and inability to afford traveling to the health facility, being unable to get facemask, fear of COVID-19 [ 29 ], and fear of visiting hospitals [ 30 ]. Similarly, two studies conducted among healthcare providers reported disruptions in HIV services amid the pandemic.…”

The impact of COVID‐19 on patients with neurological disorders and their access to healthcare in Africa: A review of the literature

“… Continued treatment: Patient compliance is critical to the effectiveness of chronic disease therapy. However, due to infrequent ART center visits, the pandemic has led to low patient compliance and adherence to medications (Ahmed et al., 2022 ). Poverty: The difficulties that patients encounter while paying for medical care due to limited financial resources and a lack of healthcare insurance facilities (Xu et al., 2003 ).…”

“…Continued treatment: Patient compliance is critical to the effectiveness of chronic disease therapy. However, due to infrequent ART center visits, the pandemic has led to low patient compliance and adherence to medications (Ahmed et al., 2022 ).…”

Interventions and Impact of Pharmacist-Delivered Services for People Infected with COVID-19: A Systematic Review

“…The sudden outbreak of SARS COV-2, a coronavirus strain that caused coronavirus disease 2019 (COVID-19), significantly impacted global healthcare systems [ 1 , 2 , 3 , 4 ]. Managing people infected with COVID-19 requires a team of competent healthcare workers, including doctors, nurses, pharmacists, and paramedics [ 5 , 6 ].…”