Initiative targets barriers to HIV drug adherence
Ten reasons cited for not taking medications
HIV patients have one thing in common with other people who have strict medication regimens: They sometimes forget to take their pills. The difference is that the repercussions of forgetting are more serious for most HIV patients. The fast-mutating virus only needs a small crack in the armor to renew its assault.
This is why Massachusetts health officials have launched an initiative examining which intervention programs work best in keeping HIV patients on their medications. And it examines why HIV patients don’t adhere to their treatment regimens.
The Community Research Initiative (CRI) of New England in Brookline, MA, conducted a comprehensive, 16-page survey of HIV-infected people in Massachusetts who received HIV/AIDS support and health care services at one of 14 sites across the state. The survey was completed by 450 HIV patients at baseline and 280 in a follow-up.
"What we found in terms of reasons why people missed taking their medications was similar to what we know from existing adherence literature," says Julie Marston, MPH, executive director of CRI.
The top 10 reasons cited were:
1. People forgot.
2. They were busy with other things.
3. They were away from home and didn’t have their drugs with them.
4. They fell asleep and slept through the dose time.
5. They had a change in their daily routine, such as a weekend, vacation, or holiday.
6. They had problems taking pills at certain times, such as if they needed to take a pill two hours after a meal.
7. They felt too depressed or overwhelmed.
8. They were too sick from the side effects.
9. They had too many pills to take.
10. They wouldn’t take the medication because they wanted to avoid side effects.
The Massachusetts initiative also found that HIV/AIDS support service and health care sites had challenges of their own to overcome before their medication adherence programs could succeed.
These barriers typically fell into three categories: work burden and complexity, attitudes and beliefs, and confidentiality.
The sites found that it takes a lot of staff time to provide adherence support to HIV patients. Both staff and patients need to be trained, and providers must address all the issues that affect adherence. Plus, the sites that used peer advocates found that there was a fairly high turnover rate among advocates.
Secondly, both providers and patients have conflicting beliefs or attitudes that affect medication adherence. For example, some drug treatment providers didn’t want to make referrals to an adherence program because it might compromise a patient’s addiction treatment. And as HIV becomes more of a chronic disease that must be treated for possibly decades, patients may be reluctant or weary of staying on these medication regimens indefinitely.
The third barrier is that HIV patients recruited for the adherence projects were fearful that their HIV status would be disclosed or that they would lose their privacy. For example, if a patient had a peer advocate who is highly visible in the community as a person who has HIV, then someone the patient knows might recognize the patient with that advocate and assume the patient has HIV. This issue was addressed by giving advocates extensive confidentiality and communication training.
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