In a systematic review of previously published studies researchers, Edward Mills and colleagues, looked at studies in both developed and developing country settings which had examined the factors that affect adherence to these regimens.
84 relevant studies were examined of which 37 used “qualitative” methods (focus groups, interviews, open-ended questioning) and 47 used “quantitative” methods (surveys). Only 12 of the studies had been carried out in the developing world.
Many barriers to adherence were common to both developed and developing settings, including fear of disclosure of HIV status, concomitant substance abuse, forgetfulness, suspicions of treatment, regimens that were too complicated, number of pills required, decreased quality of life, and work and family responsibilities. Factors unique to the studies conducted in the developing world included financial constraints and problems with traveling to get access to treatment.
Important facilitators (factors that made adherence easier) reported by patients in developed nation settings included having a sense of self-worth, seeing positive effects of antiretroviral drugs, acceptance of HIV status, understanding of the need for strict adherence, making use of reminder tools, and having a simple regimen. No facilitators to adherence were discussed in any study in a developing nation setting.
The authors conclude that “clinicians should use this information to engage in open discussion with patients to promote adherence and identify barriers and facilitators within their own populations”. However, they note that in developing country settings, “the reliability of medication access is an important adherence barrier that individuals have little opportunity to facilitate. Patient-level adherence can be determined only when a steady supply of medication exists.”
Citation: Mills EJ, Nachega JB, Bangsberg DR, Singh S, Rachlis B, et al. (2006) Adherence to antiretroviral therapy: A systematic review of developed and developing nation patient-reported barriers and facilitators. PLoS Med 3(11): e438.
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