TY - JOUR
T1 - Barriers and enablers for adherence to antiretroviral therapy among people living with HIV/AIDS in the era of COVID-19
T2 - A qualitative study from Pakistan
AU - Ahmed, Ali
AU - Dujaili, Juman Abdulelah
AU - Jabeen, Musarat
AU - Umair, Malik Muhammad
AU - Chuah, Lay Hong
AU - Hashmi, Furqan Khurshid
AU - Awaisu, Ahmed
AU - Chaiyakunapruk, Nathorn
N1 - Funding Information:
We thank the National AIDS Control Programme of Pakistan, and the HIV case manager (Hassan Mansoor Malik) of PIMS Hospital, for assisting us with data collection and the smooth running of the study. We would also like to thank Dr. Rabia Hussain for her suggestions in the development of the interview guide and HIV patients for their voluntary participation in the study.
Publisher Copyright:
Copyright © 2022 Ahmed, Dujaili, Jabeen, Umair, Chuah, Hashmi, Awaisu and Chaiyakunapruk.
PY - 2022/1/28
Y1 - 2022/1/28
N2 - 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.
AB - 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.
KW - antiretrovirals
KW - barriers and facilitative factors
KW - challenges
KW - interventions
KW - Pakistan
KW - people living with HIV/AIDS
KW - UNAIDS
UR - http://www.scopus.com/inward/record.url?scp=85124612546&partnerID=8YFLogxK
U2 - 10.3389/fphar.2021.807446
DO - 10.3389/fphar.2021.807446
M3 - Article
C2 - 35153763
AN - SCOPUS:85124612546
SN - 1663-9812
VL - 12
JO - Frontiers in Pharmacology
JF - Frontiers in Pharmacology
M1 - 807446
ER -
