Understanding the facilitators and barriers of antiretroviral adherence in Peru: A qualitative study

Abstract

BackgroundAntiretroviral scale-up is increasing in resource-constrained settings. To date, few studies have explored the barriers and facilitators of adherence to ART in these settings. Facilitators and barriers of antiretroviral adherence in Peru are not completely understood.MethodsAt two clinics that serve a large number of HIV-positive individuals in Lima, Peru, 31 in-depth interviews were carried out in 2006 with adult HIV-positive individuals receiving ART. Purposive sampling was used to recruit the participants. Interviews were transcribed and coded using two Spanish-speaking researchers and a content analysis approach to identify themes in the data.ResultsAmong the participants, 28/31 (90%) were male, 25/31 (81%) were self-identified as mestizo, and 19/31 (61%) had an education above high school. The most frequently discussed barriers to adherence included side effects, simply forgetting, inconvenience, dietary requirements, being away from home, and fear of disclosure/stigma. The most frequently discussed facilitators to adherence included having a fixed routine, understanding the need for compliance, seeing positive results, treatment knowledge, and faith in treatment.ConclusionsOverall, these findings were similar to the facilitators and challenges experienced by individuals on ART in other resource constrained settings. Further treatment support tools and networks should be developed to decrease the challenges of ART adherence for HIV-positive individuals in Lima, Peru.

Alcohol use disorders negatively influence antiretroviral medication adherence among men who have sex with men in Peru

“…Unlike a recent report conferring benefit among HIV-infected Peruvian men without assessment of alcohol or drug use [84], various reminders did not significantly influence ART adherence in our sample. Though not shown, those with AUDs were no more likely to use medication reminders than those without them.…”

“…In our analyses, we did not explore in detail the impact of various types of stigma on ART adherence, but it is seductive to speculate that those who do not disclose their HIV status to others continually live in fear and miss doses based on concerns about someone finding out about their HIV status – as shown by previous studies conducted in Peru [84]. Further inquiry into various types of stigma is crucial for intervention development, especially with regard to HIV disclosure.…”

Validation of 2 Spanish-Language Scales to Assess HIV-Related Stigma in Communities

“…27 Prior work in Lima found that fear of stigma or unwanted disclosure was a key barrier to adherence among PLWHA. 28 …”

Advancing Pharmacy Practice Through Social Theory

“…20 Barriers to MA were equally diverse and included patient factors (simply forgetting to take pills, fear of stigma, high cost of therapy), negative beliefs about medication (side effects, medications are harmful or ineffective), difficult medication schedule (dietary requirements with some pills, being away from home, being too busy) and other factors (mistrust in providers, feeling healthy, feeling hopeless, pill size, continued substance abuse).…”

“…Participants in the study by Curioso et al stated they had a positive relationship with their providers that promoted MA while the participants in the study by Wayson-Locher et al stated that a lack of trust in their providers had a negative impact on MA. 18,20 Consequently, the concept of "trust" can be placed into both the facilitator and barrier categories depending on the perspective used in the original study.…”